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Contact Information

JEFFREY S WEATHERALL, MD
135 W RAVINE
STE 5B
KINGSPORT, TN37660-3847
 Phone: 423-224-3460
 Fax: 423-224-3465
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Anesthesiology

207L00000X 79 Physician/Addiction Medicine
Indicates primary specialty

NPI Profile & details for JEFFREY S WEATHERALL · (Male)

NPI # 1093752081
Status Active
Credentials MD
Entity Individual
Enumeration date 05/31/2006
Last updated 04/12/2017 - About 9 years ago
Sole proprietor 1 No
Identifiers
  • TN License # 34933
  • KY Medicaid 64032592
  • TN Medicaid 3868408
  • VA Medicaid 010258693
  • Other 4119268 BCBST
  • Other P00303258 RAILROAD MEDICARE
Hospital affiliation(s)
  • INDIAN PATH MEDICAL CENTER - (Acute Care)
    2000 BROOKSIDE DR
    KINGSPORT, TN 37660
  • WELLMONT HOLSTON VALLEY MEDICAL CENTER - (Acute Care)
    130 WEST RAVINE ROAD
    KINGSPORT, TN 37662
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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