Healthcare Provider Details

I. General information

NPI: 1235162298
Provider Name (Legal Business Name): PEDIATRIC OTOLARYNGOLOGY HEAD AND NECK SURGERY,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W CLINCH AVE SUITE 410
KNOXVILLE TN
37916-2219
US

IV. Provider business mailing address

2100 W CLINCH AVE SUITE 410
KNOXVILLE TN
37916-2219
US

V. Phone/Fax

Practice location:
  • Phone: 865-521-6005
  • Fax: 865-521-6088
Mailing address:
  • Phone: 865-521-6005
  • Fax: 865-521-6088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number
License Number StateTN

VIII. Authorized Official

Name: DR. JOHN P LITTLE
Title or Position: CHIEF MANAGER
Credential: M.D.
Phone: 865-521-6005