Healthcare Provider Details

I. General information

NPI: 1902827728
Provider Name (Legal Business Name): CHRISTOPHER SCOTT CALLICUTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6408 PAPERMILL DR
KNOXVILLE TN
37919-4858
US

IV. Provider business mailing address

PO BOX 52948
KNOXVILLE TN
37950-2948
US

V. Phone/Fax

Practice location:
  • Phone: 865-588-8229
  • Fax: 865-212-0163
Mailing address:
  • Phone: 865-306-5675
  • Fax: 865-584-7712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD0000044749
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: