Individual
AMANDA DAVIS INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
103 W STONE DR, KINGSPORT, TN 37660
(423) 968-1144
Mailing address
3053 W STATE ST, BRISTOL, TN 37620-1720
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
35098925
OH
2085R0202X
Diagnostic Radiology Physician
Primary
49584
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q001537
—
TN
Enumeration date
08/15/2008
Last updated
10/26/2018
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