Individual
SHANE ADAM DANIELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
105 W STONE DR, STE 3A, KINGSPORT, TN 37660-3365
(423) 392-6200
(423) 392-6593
Mailing address
PO BOX 9, KINGSPORT, TN 37662-0009
(423) 857-2066
(423) 857-2070
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2379
TN
Other
Enumeration date
07/23/2013
Last updated
12/16/2015
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