Healthcare Provider Details

I. General information

NPI: 1184263154
Provider Name (Legal Business Name): REGINA A. ADCOCK CO, LO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 PARKWEST BLVD. SUITE 103
KNOXVILLE TN
37923
US

IV. Provider business mailing address

PO BOX 3264
MORRISTOWN TN
37815-3264
US

V. Phone/Fax

Practice location:
  • Phone: 423-318-8824
  • Fax: 423-318-2872
Mailing address:
  • Phone: 423-318-8824
  • Fax: 423-318-2872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberORT0000000024
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: