Healthcare Provider Details

I. General information

NPI: 1770133597
Provider Name (Legal Business Name): RENEWAL HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7035 MIDDLEBROOK PIKE
KNOXVILLE TN
37909
US

IV. Provider business mailing address

7035 MIDDLEBROOK PIKE
KNOXVILLE TN
37909
US

V. Phone/Fax

Practice location:
  • Phone: 865-200-8672
  • Fax: 865-544-1570
Mailing address:
  • Phone: 865-200-8672
  • Fax: 865-544-1570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. STACY L. PINSON
Title or Position: NURSE PRACTITIONER/OWNER
Credential: FNP-C
Phone: 865-789-9165