Healthcare Provider Details

I. General information

NPI: 1356359319
Provider Name (Legal Business Name): HALLS PHYSICIAN SERVICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 MAYNARDVILLE HWY HALLS PHYSICIAN SERVICES PLLC
KNOXVILLE TN
37915
US

IV. Provider business mailing address

7000 MAYNARDVILLE HWY
KNOXVILLE TN
37918
US

V. Phone/Fax

Practice location:
  • Phone: 865-922-1400
  • Fax: 865-922-0928
Mailing address:
  • Phone: 865-922-1400
  • Fax: 865-922-0928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HANA H MIRANI
Title or Position: OFFICE MANAGER
Credential:
Phone: 865-922-1400