Healthcare Provider Details

I. General information

NPI: 1912076506
Provider Name (Legal Business Name): PEDIATRIC CONSULTANTS OF EAST TENNESSEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 06/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 ALCOA HWY SUITE 145
KNOXVILLE TN
37920-1500
US

IV. Provider business mailing address

1930 ALCOA HWY SUITE 145
KNOXVILLE TN
37920-1500
US

V. Phone/Fax

Practice location:
  • Phone: 865-582-3100
  • Fax: 865-544-6572
Mailing address:
  • Phone: 865-582-3100
  • Fax: 865-544-6572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: CAMILLA JOCHER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 865-582-3100