Provider Demographics
NPI:1144290552
Name:COMBS, STEPHEN P (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:P
Last Name:COMBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 MED TECH PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2579
Mailing Address - Country:US
Mailing Address - Phone:423-302-6565
Mailing Address - Fax:423-952-2175
Practice Address - Street 1:115 JUDGE GRESHAM RD
Practice Address - Street 2:SUITE B
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615-6213
Practice Address - Country:US
Practice Address - Phone:423-477-2885
Practice Address - Fax:423-477-0113
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26795208000000X, 2080A0000X
VA0101259182208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3095016Medicaid
G12387Medicare UPIN
VAVVK449B288Medicare PIN
VA3095016Medicaid
TN103I372935Medicare PIN