Basic Information
Provider Information
NPI: 1861050015
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: THOMAS
FirstName: AKESH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MBBS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1924 ALCOA HWY # U-114
Address2:  
City: KNOXVILLE
State: TN
PostalCode: 379201511
CountryCode: US
TelephoneNumber: 4234396283
FaxNumber:  
Practice Location
Address1: JOHNSON CITY MEDICAL CENTER
Address2: 400 N STATE OF FRANKLIN RD
City: JOHNSON CITY
State: TN
PostalCode: 37604
CountryCode: US
TelephoneNumber: 4234316111
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/03/2019
LastUpdateDate: 05/22/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/22/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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