Healthcare Provider Details

I. General information

NPI: 1245638394
Provider Name (Legal Business Name): WALLY CHAMI N/A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6545 CLINTON HWY
KNOXVILLE TN
37912-1115
US

IV. Provider business mailing address

6545 CLINTON HWY
KNOXVILLE TN
37912-1115
US

V. Phone/Fax

Practice location:
  • Phone: 865-230-5491
  • Fax:
Mailing address:
  • Phone: 865-230-5491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number115499131
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: