MEDICARE: APPA LLC

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	174	TN
2	207Q00000X	Family Medicine Physician	174	TN

General Provider Information

NPI Number	:	1629581574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APPA LLC

Provider Business Mailing Address
First Line	:	431 PARK VILLAGE DR #103
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923
Country	:	US
Telephone Number	:	865-247-5590
Fax Number	:	865-312-9150

Provider Business Practice Location Address
First Line	:	431 PARK VILLAGE RD STE 103
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-3806
Country	:	US
Telephone Number	:	865-247-5590
Fax Number	:	865-312-9150

Authorized Official
Title or Position	:	OWNER
Name	:	DOUGLAS E LILLIFIELD
Credential	:	PA C
Telephone Number	:	865-247-5590

Provider Enumeration Date	:	11/14/2017
Last Update Date	:	11/14/2017

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Directions to “APPA LLC ” Practice Location

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