Healthcare Provider Details

I. General information

NPI: 1316380744
Provider Name (Legal Business Name): DAVIS PAPPANDREOU BERRY M.D,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 06/20/2021
Certification Date: 06/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1932 ALCOA HWY STE 270
KNOXVILLE TN
37920-1537
US

IV. Provider business mailing address

PO BOX 415000-MSC8231
NASHVILLE TN
37241-8182
US

V. Phone/Fax

Practice location:
  • Phone: 865-251-4658
  • Fax: 865-251-4659
Mailing address:
  • Phone: 865-670-6199
  • Fax: 865-670-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number59975
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number59975
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number59975
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: