Healthcare Provider Details

I. General information

NPI: 1235457151
Provider Name (Legal Business Name): JONATHAN DAVID BOONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1926 ALCOA HWY STE 410
KNOXVILLE TN
37920-1545
US

IV. Provider business mailing address

1700 6TH AVE S ROOM 10250
BIRMINGHAM AL
35233-1802
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-5622
  • Fax: 865-305-4580
Mailing address:
  • Phone: 205-934-4986
  • Fax: 205-975-6415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number55411
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: