Healthcare Provider Details

I. General information

NPI: 1225038490
Provider Name (Legal Business Name): DEVAPIRAN JAISHANKAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAISHANKAR DEVAPIRAN M.D.

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 TUSCULUM BLVD STE 2200
GREENEVILLE TN
37745-5822
US

IV. Provider business mailing address

900 E HILL AVE STE 230
KNOXVILLE TN
37915-2565
US

V. Phone/Fax

Practice location:
  • Phone: 423-639-0243
  • Fax: 423-639-0628
Mailing address:
  • Phone: 865-862-0998
  • Fax: 865-544-1861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number45463
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: