Healthcare Provider Details

I. General information

NPI: 1366760563
Provider Name (Legal Business Name): JONATHAN DAVID YORK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 09/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1932 ALCOA HWY STE 360
KNOXVILLE TN
37920-1509
US

IV. Provider business mailing address

1932 ALCOA HWY SUITE 360
KNOXVILLE TN
37920-1508
US

V. Phone/Fax

Practice location:
  • Phone: 865-524-1869
  • Fax: 865-544-6533
Mailing address:
  • Phone: 865-524-1869
  • Fax: 865-544-6533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD.60655602
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number55803
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: