Healthcare Provider Details

I. General information

NPI: 1639307242
Provider Name (Legal Business Name): CHARISSA LYNN MANUAT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 CLINCH AVE 5TH FLOOR SOUTH TOWER - NICU
KNOXVILLE TN
37916-2301
US

IV. Provider business mailing address

2018 CLINCH AVENUE 5TH FLOOR SOUTH TOWER - NICU
KNOXVILLE TN
37916-2301
US

V. Phone/Fax

Practice location:
  • Phone: 865-541-8155
  • Fax: 865-541-8649
Mailing address:
  • Phone: 865-541-8155
  • Fax: 865-541-8649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number31764
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number50700
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number20760
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number70397
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036130274
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: