Healthcare Provider Details

I. General information

NPI: 1750362703
Provider Name (Legal Business Name): MICHAEL CHRISTOPHER DOODY MD, PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 FORT SANDERS WEST BLVD SUITE 106
KNOXVILLE TN
37922-3398
US

IV. Provider business mailing address

220 FORT SANDERS WEST BLVD SUITE 106
KNOXVILLE TN
37922-3398
US

V. Phone/Fax

Practice location:
  • Phone: 865-531-3011
  • Fax: 865-531-7582
Mailing address:
  • Phone: 865-531-3011
  • Fax: 865-531-7582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD18002
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: