Healthcare Provider Details

I. General information

NPI: 1346274420
Provider Name (Legal Business Name): EAST TENNESSEE NEONATAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 SAINT MARY ST
KNOXVILLE TN
37917-4517
US

IV. Provider business mailing address

1718 SAINT MARY ST
KNOXVILLE TN
37917-4517
US

V. Phone/Fax

Practice location:
  • Phone: 865-637-5908
  • Fax:
Mailing address:
  • Phone: 865-637-5908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMMY HATFIELD
Title or Position: OFFICE MANAGER
Credential:
Phone: 865-637-5908