Individual
KOYAMANGALATH KRISHNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 PROFESSIONAL PARK DR, STE 21, JOHNSON CITY, TN 37604-6587
(423) 232-6900
(423) 232-6903
Mailing address
1 PROFESSIONAL PARK DR, STE 21, JOHNSON CITY, TN 37604-6587
(423) 232-6900
(423) 232-6903
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
30191
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144241464
—
VA
05
—
3822354
—
TN
01
—
P00867848
RAILROAD MEDICARE
TN
05
—
Q020981
—
TN
Enumeration date
07/21/2006
Last updated
02/15/2017
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