MEDICARE: TMS OF EAST TENNESSEE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1033752597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TMS OF EAST TENNESSEE PLLC

Provider Business Mailing Address
First Line	:	10241 KINGSTON PIKE STE 2
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-3240
Country	:	US
Telephone Number	:	865-691-1165
Fax Number	:	865-690-6042

Provider Business Practice Location Address
First Line	:	10241 KINGSTON PIKE STE 2
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-3240
Country	:	US
Telephone Number	:	865-691-1165
Fax Number	:	865-690-6042

Authorized Official
Title or Position	:	TMS COORDINATOR
Name	:	EMILY DEVENTE
Credential	:	LPN
Telephone Number	:	865-691-1165

Provider Enumeration Date	:	10/28/2019
Last Update Date	:	04/02/2020

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