Healthcare Provider Details

I. General information

NPI: 1265666747
Provider Name (Legal Business Name): EAST TENNESSEE PEDIATRIC CARDIOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 WHITE AVE FL TOWER2
KNOXVILLE TN
37916-2209
US

IV. Provider business mailing address

2012 WHITE AVE FL TOWER2
KNOXVILLE TN
37916-2209
US

V. Phone/Fax

Practice location:
  • Phone: 865-522-0420
  • Fax: 865-246-7564
Mailing address:
  • Phone: 865-522-0420
  • Fax: 865-971-1597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: YVONNE BREMER
Title or Position: MEDICAL DOCOTOR
Credential:
Phone: 865-522-0420