Healthcare Provider Details

I. General information

NPI: 1306834619
Provider Name (Legal Business Name): JOE ALAN GRAVES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W CLINCH AVE SUITE 330
KNOXVILLE TN
37916-2219
US

IV. Provider business mailing address

2100 W CLINCH AVE SUITE 330
KNOXVILLE TN
37916-2219
US

V. Phone/Fax

Practice location:
  • Phone: 865-673-8229
  • Fax: 865-673-8893
Mailing address:
  • Phone: 865-673-8229
  • Fax: 865-673-8893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberMD23686
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number35C.001878
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: