Healthcare Provider Details

I. General information

NPI: 1154832061
Provider Name (Legal Business Name): EMILY A OAKS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6965 CUMBERLAND GAP PKWY
HARROGATE TN
37752-8245
US

IV. Provider business mailing address

301 MARINER POINT DR
CLINTON TN
37716-5997
US

V. Phone/Fax

Practice location:
  • Phone: 423-869-3611
  • Fax:
Mailing address:
  • Phone: 865-803-1851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: