Organization
PULMONARY ASSOCIATES OF KINGSPORT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIRLEY HAWKINS (ADMINISTRATOR)
(423) 247-5197
Entity
Organization
Contact information
Practice address
111 W STONE DR, SUITE 100, KINGSPORT, TN 37660-6027
(423) 247-5197
(423) 247-5254
Mailing address
111 W STONE DR, SUITE 100, KINGSPORT, TN 37660-6027
(423) 247-5197
(423) 247-5254
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
055800
ANTHEM
VA
01
—
1387788
UMWA
TN
01
—
288792
FEDERAL BLACK LUNG
TN
05
—
3700107
—
TN
01
—
65906208
KENTUCKY MEDICAID
KY
01
—
85538
BLUE CROSS BLE SHIELD
TN
Enumeration date
05/17/2006
Last updated
06/15/2011
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