Healthcare Provider Details

I. General information

NPI: 1700497302
Provider Name (Legal Business Name): GENESIS NEUROSCIENCE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 DOWELL SPRINGS BLVD STE 340
KNOXVILLE TN
37909-2445
US

IV. Provider business mailing address

PO BOX 10367
KNOXVILLE TN
37939-0367
US

V. Phone/Fax

Practice location:
  • Phone: 865-584-7376
  • Fax: 865-444-7672
Mailing address:
  • Phone: 865-584-7376
  • Fax: 865-540-3856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MONICA K. CRANE
Title or Position: DIRECTOR
Credential: MD
Phone: 865-888-9494