Healthcare Provider Details

I. General information

NPI: 1801356985
Provider Name (Legal Business Name): NICHOLAS BRUCE CLINE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 08/11/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N WEISGARBER RD STE 200
KNOXVILLE TN
37909-2707
US

IV. Provider business mailing address

801 N WEISGARBER RD STE 200
KNOXVILLE TN
37909-2707
US

V. Phone/Fax

Practice location:
  • Phone: 865-584-8589
  • Fax:
Mailing address:
  • Phone: 865-584-8589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number71631
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: