Unknown Individual – Neurological Surgery Physician, NPI 1376504332

Neurological Surgery Physician

Unknown Individual is a healthcare provider. based in Kingsport, Tennessee. specializing in Neurological Surgery Physician. They hold a License No. 23552 (TN). The NPI Number for Unknown Individual is 1376504332

Main info

Organization

Inactive

44 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1376504332

Phone

(423) 578-1518

Address

444 CLINCHFIELD ST

Deactivation Date

1 February 2022

Doctor Profile

Medical School Name

UNIVERSITY OF VIRGINIA SCHOOL OF MEDICINE

Secondary Phone

4233987020

Graduation Year

1982 (44 years ago)

PAC ID

0143277822

Group Practice PAC ID

8123291739

Professional Enrollment ID

I20101118000348

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness75

Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

Clinchfield Street, Cherokee Village, Kingsport, Sullivan County, Tennessee, 37660-3610, United States
SUITE 103
KINGSPORT, TN 376603606
Phone: (423) 578-1518
Fax: (423) 230-6349
Type: Location
Paducah Post Office, South 4th Street, Paducah, McCracken County, Kentucky, 42003, United States
PADUCAH, KY 420029150
Phone: (270) 744-9600
Fax: (270) 744-0834
Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 37660)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 8123291739View full group profile

Name	Specialty	State
JACQUELYN BURT	-	TN
SHERRY LYNN GOODE (NP)	-	TN
DR. WILLIAM ROBERT BRIDGES (M.D.)	General Surgery	MD
ROGER J MCSHARRY (MD)	Pulmonary Disease, Internal Medicine	TN
DR. RAIF WASSEF ELSAKR (M.D.)	G A S T R O E N T E R O L O G Y	TN
DR. JON WILLIAM TAVEAU	N E U R O S U R G E R Y	IL
MRS. PAGE S STERLING (APRN)	Nurse Practitioner	TN
GABRILLE ELAINE HAMILTON (FNP)	-	TN
MR. WESLEY EUGENE PERRY (PA)	Physician Assistant	KY
ROBERT M HARRIS (MD)	Orthopedic Surgery	GA