Healthcare Provider Details

I. General information

NPI: 1407094550
Provider Name (Legal Business Name): GI FOR KIDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W CLINCH AVE
KNOXVILLE TN
37916-2219
US

IV. Provider business mailing address

1701 ALCOTT MANOR LN
KNOXVILLE TN
37922-8096
US

V. Phone/Fax

Practice location:
  • Phone: 865-546-3998
  • Fax:
Mailing address:
  • Phone: 865-546-3998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. YOUHANNA S. AL-TAWIL
Title or Position: OWNER
Credential: M.D.
Phone: 865-546-3998