Individual
DAVID A. SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
130 W RAVINE RD, KINGSPORT, TN 37660-3810
(423) 968-1144
(423) 968-3453
Mailing address
3053 W STATE ST, BRISTOL, TN 37620-1720
(423) 968-1144
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
36170
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007214758
—
VA
01
—
245789
ANTHEM (BCBS VA)
VA
01
—
300130692
PGBA (RR MEDICARE)
—
01
—
4036109
BCBS TN
TN
05
—
6469708900
—
KY
01
—
R06903
JOHN DEERE
TN
Enumeration date
08/22/2005
Last updated
12/20/2013
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