Healthcare Provider Details

I. General information

NPI: 1659676906
Provider Name (Legal Business Name): DANIEL D SALMON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 03/27/2022
Certification Date: 03/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 HWY 45 NORTH
HENDERSON TN
38340-4003
US

IV. Provider business mailing address

1275 DICK LONAS RD UNIT 101
KNOXVILLE TN
37909-1383
US

V. Phone/Fax

Practice location:
  • Phone: 731-989-9899
  • Fax: 731-989-3495
Mailing address:
  • Phone: 865-584-4747
  • Fax: 865-584-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.738
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2082
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: