Individual
SCOTT E MAYNARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
135 W RAVINE RD, SUITE 5-B, KINGSPORT, TN 37660-3847
(423) 224-3460
(423) 224-3465
Mailing address
PO BOX 535744, ATLANTA, GA 30353-5510
(844) 294-5114
(865) 691-0843
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
16269
ND
207L00000X
Anesthesiology Physician
Primary
40808
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010343488
—
VA
05
—
3820575
—
TN
01
—
4127819
BCBST
—
01
—
P00337665
RAILROAD MEDICARE
—
Enumeration date
07/05/2006
Last updated
12/28/2023
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