Active NPI
Landon A Colquitt IV, M.D.
- Anatomic Pathology & Clinical Pathology Physician
- Kingsport, TN
National Provider Identifier
1629054556
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 19720
- Practice address
- 130 W Ravine Rd
Kingsport, TN 37660-3810 - Phone
- (423) 224-6718
- Fax
- (423) 224-6717
- NPI assigned
- Dec 22, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 19720 | TN | Primary |
Addresses
Primary practice location
130 W Ravine Rd
Kingsport, TN 37660-3810
Mailing address
2175 Highway 75
Suite 4
Blountville, TN 37617
Phone (423) 323-5290
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19720 | TN | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475107200000",
"number": "1629054556",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2175 HIGHWAY 75",
"address_2": "SUITE 4",
"city": "BLOUNTVILLE",
"state": "TN",
"postal_code": "37617",
"telephone_number": "423-323-5290",
"fax_number": "423-323-5653"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 W RAVINE RD",
"city": "KINGSPORT",
"state": "TN",
"postal_code": "376603810",
"telephone_number": "423-224-6718",
"fax_number": "423-224-6717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLQUITT",
"first_name": "LANDON",
"middle_name": "A",
"name_suffix": "IV",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-22",
"last_updated": "2016-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "TN",
"license": "19720",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kingsport, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.