Healthcare Provider Details

I. General information

NPI: 1508297367
Provider Name (Legal Business Name): WEST SIDE MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2013
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9957 KINGSTON PIKE SUITE 105
KNOXVILLE TN
37922-6908
US

IV. Provider business mailing address

9957 KINGSTON PIKE SUITE 105
KNOXVILLE TN
37922-6908
US

V. Phone/Fax

Practice location:
  • Phone: 865-862-4575
  • Fax: 865-909-9397
Mailing address:
  • Phone: 865-862-4575
  • Fax: 865-909-9397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID M SELLERS
Title or Position: OWNER
Credential: M.D.
Phone: 865-862-4575