Healthcare Provider Details

I. General information

NPI: 1932308293
Provider Name (Legal Business Name): EAST TENN NEUROLOGY CL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9430 PARKWEST BLVD SUITE 350
KNOXVILLE TN
37923-4203
US

IV. Provider business mailing address

9430 PARKWEST BLVD SUITE 350
KNOXVILLE TN
37923
US

V. Phone/Fax

Practice location:
  • Phone: 865-531-9430
  • Fax: 865-531-9580
Mailing address:
  • Phone: 865-531-9430
  • Fax: 865-531-9580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberMD17875
License Number StateTN

VIII. Authorized Official

Name: DR. SAM AL-KABBANI
Title or Position: PRESIDENT
Credential: MD
Phone: 865-531-9430