Healthcare Provider Details

I. General information

NPI: 1093758187
Provider Name (Legal Business Name): ASHISH VIJAY PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 CUSICK RD STE A
ALCOA TN
37701-3192
US

IV. Provider business mailing address

12236 PATAGONIA LN
KNOXVILLE TN
37922-1909
US

V. Phone/Fax

Practice location:
  • Phone: 865-888-6923
  • Fax:
Mailing address:
  • Phone: 423-943-3001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number4301109047
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number39013
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: