Provider Demographics
NPI:1093978330
Name:DOVE, AMANDA A (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:A
Last Name:DOVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:999 EXECUTIVE PARK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4632
Mailing Address - Country:US
Mailing Address - Phone:423-224-3250
Mailing Address - Fax:423-224-3258
Practice Address - Street 1:405 SCENIC DR
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-2441
Practice Address - Country:US
Practice Address - Phone:423-272-2111
Practice Address - Fax:423-272-7667
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2012-08-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC30920207Q00000X
TN47342207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I082942Medicare PIN
TN103I084444Medicare PIN