Healthcare Provider Details

I. General information

NPI: 1457731796
Provider Name (Legal Business Name): HANNAH BYLAND VEGA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

1924 ALCOA HWY # U-109
KNOXVILLE TN
37920-1511
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-9220
  • Fax:
Mailing address:
  • Phone: 865-305-9220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number82073
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: