MEDICARE: DERMATOLOGY ASSOCIATES OF KNOXVILLE, PC

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	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1407873284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMATOLOGY ASSOCIATES OF KNOXVILLE, PC

Provider Business Mailing Address
First Line	:	939 E EMERALD AVE
Second Line	:	SUITE 705
City	:	KNOXVILLE
State	:	TN
Zip	:	37917-4540
Country	:	US
Telephone Number	:	865-524-2547
Fax Number	:	865-524-0224

Provider Business Practice Location Address
First Line	:	939 E EMERALD AVE
Second Line	:	SUITE 705
City	:	KNOXVILLE
State	:	TN
Zip	:	37917-4540
Country	:	US
Telephone Number	:	865-524-2547
Fax Number	:	865-524-0224

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EDWARD J PRIMKA
Credential	:	MD
Telephone Number	:	865-524-2547

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	11/03/2014

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