Healthcare Provider Details

I. General information

NPI: 1154374262
Provider Name (Legal Business Name): SCOTT LAWRENCE STEVENS SCOTT STEVENS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY BOX U-11
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

1924 ALCOA HWY BOX U-11
KNOXVILLE TN
37920-1511
US

V. Phone/Fax

Practice location:
  • Phone: 865-544-9289
  • Fax: 865-690-5771
Mailing address:
  • Phone: 865-544-9289
  • Fax: 865-690-5771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD19831
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: