Healthcare Provider Details

I. General information

NPI: 1114023447
Provider Name (Legal Business Name): HUSSEIN ALWAN KAMMONA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HIGHWAY
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

1608 PERSIMMON LN
KNOXVILLE TN
37922-7126
US

V. Phone/Fax

Practice location:
  • Phone: 865-544-9000
  • Fax: 865-539-8008
Mailing address:
  • Phone: 865-320-6008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD30198
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number30198
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: