Healthcare Provider Details

I. General information

NPI: 1689682395
Provider Name (Legal Business Name): SALWA FAHED AL KHOURY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 DUTCH VALLEY DR
KNOXVILLE TN
37918-1424
US

IV. Provider business mailing address

PO BOX 15004
KNOXVILLE TN
37901-5004
US

V. Phone/Fax

Practice location:
  • Phone: 865-689-1122
  • Fax: 866-340-3781
Mailing address:
  • Phone: 865-541-8895
  • Fax: 865-633-4808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35936
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: