Healthcare Provider Details

I. General information

NPI: 1265156079
Provider Name (Legal Business Name): RAYVYN MACKENZIE FAYTH JAMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 MARTIN LUTHER KING JR AVE
KNOXVILLE TN
37915-1570
US

IV. Provider business mailing address

1923 SULPHUR SPRINGS RD
MORRISTOWN TN
37813-5654
US

V. Phone/Fax

Practice location:
  • Phone: 865-522-6097
  • Fax: 865-540-1611
Mailing address:
  • Phone: 423-317-9344
  • Fax: 423-317-9344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: