Healthcare Provider Details

I. General information

NPI: 1740332220
Provider Name (Legal Business Name): SOUTHERN MEDICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 NIGHTINGALE LN
KNOXVILLE TN
37909-2754
US

IV. Provider business mailing address

6600 NIGHTINGALE LN
KNOXVILLE TN
37909-2754
US

V. Phone/Fax

Practice location:
  • Phone: 865-632-5885
  • Fax: 865-632-5893
Mailing address:
  • Phone: 865-632-5885
  • Fax: 865-632-5893

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: KATHY A KANIPE
Title or Position: CREDENTIALING
Credential:
Phone: 865-632-5885