Healthcare Provider Details

I. General information

NPI: 1154546927
Provider Name (Legal Business Name): J. CAROLINE HANEY-WEAVER, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 E EMERALD AVE SUITE 612
KNOXVILLE TN
37917-4539
US

IV. Provider business mailing address

930 E EMERALD AVE SUITE 612
KNOXVILLE TN
37917-4539
US

V. Phone/Fax

Practice location:
  • Phone: 865-673-0092
  • Fax: 865-637-3443
Mailing address:
  • Phone: 865-673-0092
  • Fax: 865-637-3443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberMD40791
License Number StateTN

VIII. Authorized Official

Name: DR. JERRIE CAROLINE HANEY-WEAVER
Title or Position: SOLO-PRACITITIONER
Credential: M.D.
Phone: 865-673-0092