Provider Demographics
NPI:1538424072
Name:EAST TN NEUROLOGY LLC
Entity type:Organization
Organization Name:EAST TN NEUROLOGY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUBROTO
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-790-1529
Mailing Address - Street 1:3555 KEITH ST NW STE 211
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-4375
Mailing Address - Country:US
Mailing Address - Phone:423-476-5406
Mailing Address - Fax:
Practice Address - Street 1:1720 GUNBARREL RD STE 306
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3192
Practice Address - Country:US
Practice Address - Phone:423-790-1529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty