Individual
GARY MICHAEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
210 WESTWOOD PL STE 110, BRENTWOOD, TN 37027-7554
(615) 206-2462
(833) 983-2043
Mailing address
102 E RAVINE RD, KINGSPORT, TN 37660-3814
(423) 245-9600
(423) 245-9634
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101045149
VA
207Q00000X
Family Medicine Physician
MD26094
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508847
—
TN
Enumeration date
01/05/2006
Last updated
10/12/2022
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