Healthcare Provider Details

I. General information

NPI: 1962363895
Provider Name (Legal Business Name): MARK PATE H.I.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/25/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S NORTHSHORE DR STE 304
KNOXVILLE TN
37919-4925
US

IV. Provider business mailing address

109 S NORTHSHORE DR STE 304
KNOXVILLE TN
37919-4925
US

V. Phone/Fax

Practice location:
  • Phone: 865-558-6000
  • Fax: 865-558-9961
Mailing address:
  • Phone: 865-558-6000
  • Fax: 865-558-9961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number0701
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: