Healthcare Provider Details

I. General information

NPI: 1780651521
Provider Name (Legal Business Name): OTILIA MIGA FAGET MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 BAUM DR
KNOXVILLE TN
37919
US

IV. Provider business mailing address

PO BOX 1999
LOUISVILLE TN
37777
US

V. Phone/Fax

Practice location:
  • Phone: 965-970-9800
  • Fax: 965-380-1461
Mailing address:
  • Phone: 865-970-1295
  • Fax: 865-380-1461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number9295
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: