Healthcare Provider Details

I. General information

NPI: 1972509297
Provider Name (Legal Business Name): NICHOLAS GRAY ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1342 OLD WEISGARBER RD
KNOXVILLE TN
37909-1291
US

IV. Provider business mailing address

9050 EXECUTIVE PARK DR STE 202A
KNOXVILLE TN
37923-4670
US

V. Phone/Fax

Practice location:
  • Phone: 865-588-0811
  • Fax:
Mailing address:
  • Phone: 865-588-0811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number39535
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: