Provider Demographics
NPI:1487032041
Name:EMBERTON, ERIC DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DOUGLAS
Last Name:EMBERTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SHERIDAN SQ STE 200
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-7393
Mailing Address - Country:US
Mailing Address - Phone:423-392-4884
Mailing Address - Fax:423-392-4820
Practice Address - Street 1:1 SHERIDAN SQ STE 200
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7393
Practice Address - Country:US
Practice Address - Phone:423-392-4884
Practice Address - Fax:423-392-4820
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN712242086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program