Healthcare Provider Details

I. General information

NPI: 1275803637
Provider Name (Legal Business Name): TENNESSEE CANCER SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 WORTH ST NW
CLEVELAND TN
37311-5074
US

IV. Provider business mailing address

900 E HILL AVE SUITE 230
KNOXVILLE TN
37915-2566
US

V. Phone/Fax

Practice location:
  • Phone: 423-339-0300
  • Fax: 423-472-5687
Mailing address:
  • Phone: 865-862-3563
  • Fax: 865-544-1861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MITCHELL D MARTIN
Title or Position: CHIEF MANAGER/PHYSICIAN
Credential: M.D.
Phone: 865-637-9330