Healthcare Provider Details

I. General information

NPI: 1982633731
Provider Name (Legal Business Name): VALI KHAIROLLAHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7035 MIDDLEBROOK PIKE STE B
KNOXVILLE TN
37909-1156
US

IV. Provider business mailing address

7035 MIDDLEBROOK PIKE STE B
KNOXVILLE TN
37909-1156
US

V. Phone/Fax

Practice location:
  • Phone: 865-544-1550
  • Fax: 865-544-1570
Mailing address:
  • Phone: 865-544-1550
  • Fax: 865-544-1570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number6853
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6853
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: