Provider Demographics
NPI:1881763175
Name:DANIEL A SLONAKER MD PC
Entity type:Organization
Organization Name:DANIEL A SLONAKER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SLONAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-743-9176
Mailing Address - Street 1:PO BOX 499
Mailing Address - Street 2:1001 NORTH MAIN AVENUE
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650-0499
Mailing Address - Country:US
Mailing Address - Phone:423-743-9176
Mailing Address - Fax:423-743-0860
Practice Address - Street 1:1001 NORTH MAIN AVENUE
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-0499
Practice Address - Country:US
Practice Address - Phone:423-743-9176
Practice Address - Fax:423-743-0860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3714636Medicaid
TN3714636Medicaid
B04365Medicare UPIN