Healthcare Provider Details

I. General information

NPI: 1548270283
Provider Name (Legal Business Name): CHILD NEUROLOGY SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W CLINCH AVE SUITE 440
KNOXVILLE TN
37916-2219
US

IV. Provider business mailing address

2100 W CLINCH AVE SUITE 440
KNOXVILLE TN
37916-2219
US

V. Phone/Fax

Practice location:
  • Phone: 865-523-5437
  • Fax: 865-523-3559
Mailing address:
  • Phone: 865-523-5437
  • Fax: 865-523-3559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. MONICA M LITMAN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 865-523-5437