MEDICARE: SIBYL WRAY MD

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	2084N0400X	Neurology Physician	031665	TN

General Provider Information

NPI Number	:	1881662591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIBYL WRAY MD

Provider Business Mailing Address
First Line	:	2060 LAKESIDE CENTRE WAY
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-6591
Country	:	US
Telephone Number	:	865-218-6222
Fax Number	:	865-218-6220

Provider Business Practice Location Address
First Line	:	2060 LAKESIDE CENTRE WAY
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-6591
Country	:	US
Telephone Number	:	865-218-6222
Fax Number	:	833-671-1059

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	09/29/2022

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