Healthcare Provider Details

I. General information

NPI: 1609081520
Provider Name (Legal Business Name): ANDREW S. FERRELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 04/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

5401 KINGSTON PIKE STE 540
KNOXVILLE TN
37919-5022
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-9661
  • Fax: 865-305-6148
Mailing address:
  • Phone: 865-584-7376
  • Fax: 865-584-8938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number27066
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2009-01616
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number48411
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: