Healthcare Provider Details

I. General information

NPI: 1467664037
Provider Name (Legal Business Name): EAST TENNESSEE EAR, NOSE & THROAT SPECIALISTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TRILLIUM WAY
CORBIN KY
40701-8426
US

IV. Provider business mailing address

800 OAK RIDGE TPKE SUITE C-100
OAK RIDGE TN
37830-6957
US

V. Phone/Fax

Practice location:
  • Phone: 606-523-8770
  • Fax:
Mailing address:
  • Phone: 865-483-2288
  • Fax: 865-482-4400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: HOLLY MICHELLE SMITH
Title or Position: PRACTICE MANAGER
Credential:
Phone: 865-483-2288