Healthcare Provider Details

I. General information

NPI: 1417712688
Provider Name (Legal Business Name): EMMA JULIANNE TULLOS BSSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2024
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 N CEDAR BLUFF RD STE 305
KNOXVILLE TN
37923-3648
US

IV. Provider business mailing address

408 N CEDAR BLUFF RD STE 305
KNOXVILLE TN
37923-3648
US

V. Phone/Fax

Practice location:
  • Phone: 865-888-5818
  • Fax: 865-888-5819
Mailing address:
  • Phone: 865-888-5818
  • Fax: 865-888-5819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: