Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080A0000X | Adolescent Medicine | 0101259182 | VA |
Y | 2080A0000X | Adolescent Medicine | 26795 | TN |
NPI | 1144290552 |
---|---|
Provider Name | Dr. Stephen P Combs |
First Address | Kingsport, TN 37660-3365 |
Second Address | Gray, TN 37615-6213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 30/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3095016 | (05) | VA |
G12387 | (02) |