Healthcare Provider Details

I. General information

NPI: 1932290798
Provider Name (Legal Business Name): ORTHOTENNESSEE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 09/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 N CHARLES G SEIVERS BLVD
CLINTON TN
37716-6705
US

IV. Provider business mailing address

90 VERMONT AVE SUITE 300
OAK RIDGE TN
37830-6474
US

V. Phone/Fax

Practice location:
  • Phone: 865-482-9025
  • Fax: 865-483-8151
Mailing address:
  • Phone: 865-482-9025
  • Fax: 865-483-8151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JON-DAVID DEESON
Title or Position: CEO
Credential:
Phone: 865-769-4545