Healthcare Provider Details

I. General information

NPI: 1194849828
Provider Name (Legal Business Name): PARKWEST GYNECOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 PARK WEST BLVD ST 302
KNOXVILLE TN
37923-4308
US

IV. Provider business mailing address

9330 PARK WEST BLVD ST 302
KNOXVILLE TN
37923-4308
US

V. Phone/Fax

Practice location:
  • Phone: 865-531-5878
  • Fax: 865-531-7690
Mailing address:
  • Phone: 865-531-5878
  • Fax: 865-531-7690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA WILLIS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 865-531-5878