Healthcare Provider Details

I. General information

NPI: 1023302882
Provider Name (Legal Business Name): EHAB MANSOOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2011
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 CHILDRENS WAY
KNOXVILLE TN
37922-7713
US

IV. Provider business mailing address

PO BOX 15010
KNOXVILLE TN
37901-5010
US

V. Phone/Fax

Practice location:
  • Phone: 865-541-8478
  • Fax: 865-769-7959
Mailing address:
  • Phone: 865-541-8187
  • Fax: 865-541-8286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number50715
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: