Provider Demographics
NPI:1548255649
Name:CARNELL, ALAN G (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:G
Last Name:CARNELL
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 1:135 W RAVINE RD
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3847
Mailing Address - Country:US
Mailing Address - Phone:423-246-6777
Mailing Address - Fax:423-246-7766
Practice Address - Street 1:235 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7455
Practice Address - Country:US
Practice Address - Phone:423-246-6777
Practice Address - Fax:423-246-7766
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD034214207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005853168Medicaid
WV1803867000Medicaid
TN4122548OtherAETNA
TN3700035Medicaid
TN3149322OtherBCBS OF TN
TN100033089OtherPHP TENNCARE
VA381180OtherANTHEM
KY64062060Medicaid
TNTN0115OtherUNITED HEALTHCARE RIVER V
VA005853168Medicaid
TNTN0115OtherUNITED HEALTHCARE RIVER V
TN3852053Medicare ID - Type Unspecified