Healthcare Provider Details

I. General information

NPI: 1346622685
Provider Name (Legal Business Name): ARCHANA WADHAWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 CLINCH AVE
KNOXVILLE TN
37916-2307
US

IV. Provider business mailing address

1901 CLINCH AVE
KNOXVILLE TN
37916-2307
US

V. Phone/Fax

Practice location:
  • Phone: 865-541-1111
  • Fax:
Mailing address:
  • Phone: 865-541-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101021731
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: