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1396187027
SHANE ADAM DANIELL
KINGSPORT, TN
NPI
1396187027
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: TN PA2379)
Enumeration Date
2013-07-23
Last Update Date
2015-12-16
Business Address
-- SHANE ADAM DANIELL PA
105 W STONE DR STE 3A
KINGSPORT, TN 37660-3365
Phone number: 423-392-6200
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Mailing Address
-- SHANE ADAM DANIELL PA
PO BOX 9
KINGSPORT, TN 37662-0009
Phone number: 423-857-2066
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