Healthcare Provider Details

I. General information

NPI: 1912992272
Provider Name (Legal Business Name): EARL EDWARD BREAZEALE, JR., MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2068 LAKESIDE CENTRE WAY
KNOXVILLE TN
37922-6591
US

IV. Provider business mailing address

2068 LAKESIDE CENTRE WAY
KNOXVILLE TN
37922
US

V. Phone/Fax

Practice location:
  • Phone: 865-342-0300
  • Fax: 865-342-0301
Mailing address:
  • Phone: 865-342-0300
  • Fax: 865-342-0300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: SUSAN BREAZEALE
Title or Position: OFFICE MANAGER
Credential:
Phone: 865-342-0300