Healthcare Provider Details

I. General information

NPI: 1598299349
Provider Name (Legal Business Name): NATIONAL LOW T CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3118 ALCOA HWY
KNOXVILLE TN
37920-4791
US

IV. Provider business mailing address

3118 ALCOA HWY
KNOXVILLE TN
37920-4791
US

V. Phone/Fax

Practice location:
  • Phone: 865-314-7125
  • Fax:
Mailing address:
  • Phone: 865-314-7125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DON COFFEY
Title or Position: VICE PRESIDENT
Credential:
Phone: 865-621-3410