Healthcare Provider Details

I. General information

NPI: 1215392030
Provider Name (Legal Business Name): GI FOR KIDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2015
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 TOWN CENTER BLVD
KNOXVILLE TN
37922-6638
US

IV. Provider business mailing address

DEPT 888260
KNOXVILLE TN
37995-8260
US

V. Phone/Fax

Practice location:
  • Phone: 865-546-3998
  • Fax: 865-546-1123
Mailing address:
  • Phone: 865-670-6199
  • Fax: 865-670-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: YOUHANNA S. AL-TAWIL
Title or Position: OWNER
Credential: MD
Phone: 865-546-3998