Provider Demographics
NPI:1942594841
Name:DAYTON INTERNAL MEDICINE, PLLC
Entity Type:Organization
Organization Name:DAYTON INTERNAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAK
Authorized Official - Middle Name:S
Authorized Official - Last Name:SEO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-775-6933
Mailing Address - Street 1:188 16TH AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-1036
Mailing Address - Country:US
Mailing Address - Phone:423-775-6933
Mailing Address - Fax:423-775-3372
Practice Address - Street 1:188 16TH AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-1036
Practice Address - Country:US
Practice Address - Phone:423-775-6933
Practice Address - Fax:423-775-3372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002990207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty