Healthcare Provider Details

I. General information

NPI: 1518934579
Provider Name (Legal Business Name): GEORGE ROBERT BADDOUR JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1926 ALCOA HWY BLDG. F, SUITE 210
KNOXVILLE TN
37920-1545
US

IV. Provider business mailing address

1926 ALCOA HWY BLDG. F, SUITE 210
KNOXVILLE TN
37920-1545
US

V. Phone/Fax

Practice location:
  • Phone: 865-546-2663
  • Fax: 865-546-9047
Mailing address:
  • Phone: 865-546-2663
  • Fax: 865-546-9047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD12140
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number12140
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: