Healthcare Provider Details

I. General information

NPI: 1205327103
Provider Name (Legal Business Name): WILLIAM A PACZKOWSKI NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 CUSICK RD
ALCOA TN
37701
US

IV. Provider business mailing address

9000 EXECUTIVE PARK DR STE C200
KNOXVILLE TN
37923-4644
US

V. Phone/Fax

Practice location:
  • Phone: 865-970-0025
  • Fax: 865-970-2089
Mailing address:
  • Phone: 865-670-6754
  • Fax: 865-670-6115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24254
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24254
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: