Healthcare Provider Details

I. General information

NPI: 1821346107
Provider Name (Legal Business Name): MIDSTATE MEDICAL ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2012
Last Update Date: 11/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 CONCORD RD STE 400
KNOXVILLE TN
37934-2940
US

IV. Provider business mailing address

PO BOX 437
HARRIMAN TN
37748-0437
US

V. Phone/Fax

Practice location:
  • Phone: 865-777-6880
  • Fax: 865-777-6881
Mailing address:
  • Phone: 865-882-2909
  • Fax: 865-882-2890

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: ERIC M REDMON
Title or Position: MBR
Credential: MD
Phone: 865-560-8787