Healthcare Provider Details

I. General information

NPI: 1407962558
Provider Name (Legal Business Name): TAMMY EWAYNE BAKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAMMY BAKER BASIRI M.D.

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 HIGHLAND AVENUE
KNOXVILLE TN
37916
US

IV. Provider business mailing address

2013 HIGHLAND AVENUE
KNOXVILLE TN
37916
US

V. Phone/Fax

Practice location:
  • Phone: 865-522-3440
  • Fax: 865-637-7195
Mailing address:
  • Phone: 865-522-3440
  • Fax: 865-637-7195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number024034
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number24034
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: