Healthcare Provider Details

I. General information

NPI: 1649524448
Provider Name (Legal Business Name): ORTHOKNOX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2012
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 PARKSIDE DR SUITE 209
KNOXVILLE TN
37934-1979
US

IV. Provider business mailing address

10810 PARKSIDE DR SUITE 209
KNOXVILLE TN
37934-1979
US

V. Phone/Fax

Practice location:
  • Phone: 865-251-3034
  • Fax: 865-966-0191
Mailing address:
  • Phone: 865-251-3034
  • Fax: 865-966-0191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number26191
License Number StateTN

VIII. Authorized Official

Name: W DAVID HOVIS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 865-251-3034