Healthcare Provider Details

I. General information

NPI: 1417218512
Provider Name (Legal Business Name): SENIOR HEALTH CONSULTANTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 MINERAL SPRINGS AVE SUITE A
KNOXVILLE TN
37917-1569
US

IV. Provider business mailing address

2620 MINERAL SPRINGS AVE SUITE A
KNOXVILLE TN
37917-1569
US

V. Phone/Fax

Practice location:
  • Phone: 865-219-6968
  • Fax: 865-219-8636
Mailing address:
  • Phone: 865-219-6968
  • Fax: 865-219-8636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number019665
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number019665
License Number StateTN

VIII. Authorized Official

Name: DR. VIJAY JETHANANDANI
Title or Position: SOLE EMPLOYEE
Credential: PRESIDENT
Phone: 865-219-6968