Individual
MR. PRATIK VAIDYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1325 E CENTER ST, KINGSPORT, TN 37664-2444
(423) 245-2078
Mailing address
1325 E CENTER ST, KINGSPORT, TN 37664-2444
(423) 245-2078
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085.007114
IL
363AM0700X
Medical Physician Assistant
Primary
4571
TN
Other
Enumeration date
07/24/2019
Last updated
04/15/2026
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