Healthcare Provider Details

I. General information

NPI: 1700930336
Provider Name (Legal Business Name): KNOXVILLE AREA STONE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 GRIFFITH ST STE 205
DAVIDSON NC
28036-9307
US

IV. Provider business mailing address

705 GRIFFITH ST STE 205
DAVIDSON NC
28036-9307
US

V. Phone/Fax

Practice location:
  • Phone: 888-557-5427
  • Fax:
Mailing address:
  • Phone: 888-557-5427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QL0400X
TaxonomyLithotripsy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JUDY RUSSELL
Title or Position: BUS. OFF. COORDINATOR
Credential:
Phone: 888-557-8457