Active NPI
Iman Fallah
- Psychiatry Physician
- Shreveport, LA
National Provider Identifier
1306580766
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 77021
- Practice address
- 1501 Kings Hwy
Shreveport, LA 71103-4228 - Phone
- (318) 626-2445
- NPI assigned
- Apr 22, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 77021 | TN | Primary |
| Psychiatry Physician | 2084P0800X | 0101288863 | VA |
Addresses
Primary practice location
1501 Kings Hwy
Shreveport, LA 71103-4228
Mailing address
1021 W Oakland Ave Ste 310
Johnson City, TN 37604-2192
Phone (423) 952-2111
Other practice location 1
312 Hospital Dr
Clintwood, VA 24228-6786
Phone (276) 926-0300
Other practice location 2
130 W Ravine Rd
Kingsport, TN 37660-3837
Phone (423) 230-8200
Other practice location 3
103 North St Ste A
Bristol, VA 24201-3201
Phone (423) 844-5300
Other practice location 4
127 Health Care Dr
Pennington Gap, VA 24277-2853
Phone (276) 299-5000
Other practice location 5
300 Med Tech Pkwy
Johnson City, TN 37604-2277
Phone (423) 302-1000
Other practice location 6
1990 Holton Ave E
Big Stone Gap, VA 24219-3350
Phone (276) 523-3111
Other practice location 7
58 Carroll St
Lebanon, VA 24266-4510
Phone (276) 883-8000
Other practice location 8
1 Medical Park Blvd
Bristol, TN 37620-7430
Phone (423) 844-1121
Other practice location 9
1519 Main St
Sneedville, TN 37869-3657
Phone (423) 733-5070
Other practice location 10
2000 Brookside Dr
Kingsport, TN 37660-4627
Phone (423) 857-7000
Other practice location 11
245 Medical Park Dr
Marion, VA 24354-1100
Phone (276) 378-1000
Other practice location 12
16000 Johnston Memorial Dr
Abingdon, VA 24211-7659
Phone (276) 258-1000
Other practice location 13
1901 S Shady St
Mountain City, TN 37683-2021
Phone (423) 727-1103
Other practice location 14
1501 W Elk Ave
Elizabethton, TN 37643-2874
Phone (423) 542-1300
Other practice location 15
1420 Tusculum Blvd
Greeneville, TN 37745-4279
Phone (423) 787-5000
Other practice location 16
851 Locust St
Rogersville, TN 37857-2407
Phone (423) 921-7000
Other practice location 17
400 N State Of Franklin Rd
Johnson City, TN 37604-6035
Phone (423) 431-6111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA, TN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Psychiatry
- Education
- Other, 2021
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1021 W Oakland Ave
Suite 310
Johnson City, TN 37604-2192
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellmont Medical Associates, Inc. | Psychiatry | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Ballad Health Medical Associates
- Family Medicine Physician
- Big Stone Gap, VA
- NPI 1174808216
-
dba Ballad Health Medical Associates
- Pulmonary Disease Physician
- Kingsport, TN
- NPI 1780986257
-
dba Ballad Health Medical Associates
- Psychiatry Physician
- Johnson City, TN
- NPI 1275393522
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1650585600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783555200000",
"number": "1306580766",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1021 W OAKLAND AVE STE 310",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376042192",
"telephone_number": "423-952-2111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 KINGS HWY",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711034228",
"telephone_number": "318-626-2445"
}
],
"practiceLocations": [
{
"address_1": "312 Hospital Dr",
"address_purpose": "LOCATION",
"city": "Clintwood",
"state": "VA",
"postal_code": "242286786",
"country_code": "US",
"telephone_number": "276-926-0300",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "130 W Ravine Rd",
"address_purpose": "LOCATION",
"city": "Kingsport",
"state": "TN",
"postal_code": "376603837",
"country_code": "US",
"telephone_number": "423-230-8200",
"fax_number": "423-230-8224",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "103 North St Ste A",
"address_purpose": "LOCATION",
"city": "Bristol",
"state": "VA",
"postal_code": "242013201",
"country_code": "US",
"telephone_number": "423-844-5300",
"fax_number": "423-844-5310",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "127 Health Care Dr",
"address_purpose": "LOCATION",
"city": "Pennington Gap",
"state": "VA",
"postal_code": "242772853",
"country_code": "US",
"telephone_number": "276-299-5000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "300 Med Tech Pkwy",
"address_purpose": "LOCATION",
"city": "Johnson City",
"state": "TN",
"postal_code": "376042277",
"country_code": "US",
"telephone_number": "423-302-1000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1990 Holton Ave E",
"address_purpose": "LOCATION",
"city": "Big Stone Gap",
"state": "VA",
"postal_code": "242193350",
"country_code": "US",
"telephone_number": "276-523-3111",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "58 Carroll St",
"address_purpose": "LOCATION",
"city": "Lebanon",
"state": "VA",
"postal_code": "242664510",
"country_code": "US",
"telephone_number": "276-883-8000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1 Medical Park Blvd",
"address_purpose": "LOCATION",
"city": "Bristol",
"state": "TN",
"postal_code": "376207430",
"country_code": "US",
"telephone_number": "423-844-1121",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1519 Main St",
"address_purpose": "LOCATION",
"city": "Sneedville",
"state": "TN",
"postal_code": "378693657",
"country_code": "US",
"telephone_number": "423-733-5070",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2000 Brookside Dr",
"address_purpose": "LOCATION",
"city": "Kingsport",
"state": "TN",
"postal_code": "376604627",
"country_code": "US",
"telephone_number": "423-857-7000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "245 Medical Park Dr",
"address_purpose": "LOCATION",
"city": "Marion",
"state": "VA",
"postal_code": "243541100",
"country_code": "US",
"telephone_number": "276-378-1000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "16000 Johnston Memorial Dr",
"address_purpose": "LOCATION",
"city": "Abingdon",
"state": "VA",
"postal_code": "242117659",
"country_code": "US",
"telephone_number": "276-258-1000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1901 S Shady St",
"address_purpose": "LOCATION",
"city": "Mountain City",
"state": "TN",
"postal_code": "376832021",
"country_code": "US",
"telephone_number": "423-727-1103",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1501 W Elk Ave",
"address_purpose": "LOCATION",
"city": "Elizabethton",
"state": "TN",
"postal_code": "376432874",
"country_code": "US",
"telephone_number": "423-542-1300",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1420 Tusculum Blvd",
"address_purpose": "LOCATION",
"city": "Greeneville",
"state": "TN",
"postal_code": "377454279",
"country_code": "US",
"telephone_number": "423-787-5000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "851 Locust St",
"address_purpose": "LOCATION",
"city": "Rogersville",
"state": "TN",
"postal_code": "378572407",
"country_code": "US",
"telephone_number": "423-921-7000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "400 N State Of Franklin Rd",
"address_purpose": "LOCATION",
"city": "Johnson City",
"state": "TN",
"postal_code": "376046035",
"country_code": "US",
"telephone_number": "423-431-6111",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FALLAH",
"first_name": "IMAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-04-22",
"last_updated": "2026-07-09",
"certification_date": "2026-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "TN",
"license": "77021",
"primary": true
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "VA",
"license": "0101288863",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.