Healthcare Provider Details

I. General information

NPI: 1821595604
Provider Name (Legal Business Name): DR. MEADE CASTLETON EDMUNDS IV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9430 PARK WEST BLVD STE 330
KNOXVILLE TN
37923-4203
US

IV. Provider business mailing address

501 20TH ST STE 204
KNOXVILLE TN
37916-1881
US

V. Phone/Fax

Practice location:
  • Phone: 865-693-6065
  • Fax:
Mailing address:
  • Phone: 865-693-6065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number68494
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: