Provider Demographics
NPI:1932308293
Name:EAST TENN NEUROLOGY CL PC
Entity Type:Organization
Organization Name:EAST TENN NEUROLOGY CL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-KABBANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-531-9430
Mailing Address - Street 1:9430 PARKWEST BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923
Mailing Address - Country:US
Mailing Address - Phone:865-531-9430
Mailing Address - Fax:865-531-9580
Practice Address - Street 1:9430 PARKWEST BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4203
Practice Address - Country:US
Practice Address - Phone:865-531-9430
Practice Address - Fax:865-531-9580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD178752084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3386763Medicaid