Healthcare Provider Details

I. General information

NPI: 1154351971
Provider Name (Legal Business Name): JAN ALLEN DEWITT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 LAND OAK RD
KNOXVILLE TN
37922-2011
US

IV. Provider business mailing address

314 QUAIL DR
JOHNSON CITY TN
37601-2038
US

V. Phone/Fax

Practice location:
  • Phone: 865-777-1300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number21904
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number21904
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number33357
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: