Healthcare Provider Details

I. General information

NPI: 1710477450
Provider Name (Legal Business Name): O.H.S. EAST KNOXVILLE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 05/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8712 ASHEVILLE HWY
KNOXVILLE TN
37924-4501
US

IV. Provider business mailing address

8712 ASHEVILLE HWY
KNOXVILLE TN
37924-4501
US

V. Phone/Fax

Practice location:
  • Phone: 865-932-3633
  • Fax: 865-932-3316
Mailing address:
  • Phone: 865-932-3633
  • Fax: 865-932-3316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberMD20351
License Number StateTN

VIII. Authorized Official

Name: JAMES HARRISON
Title or Position: OWNER
Credential: MD
Phone: 865-932-3633