Healthcare Provider Details

I. General information

NPI: 1669940052
Provider Name (Legal Business Name): EMILY HOLCOMB SPIRES CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date: 07/11/2023
Reactivation Date: 07/28/2023

III. Provider practice location address

2018 WESTERN AVE
KNOXVILLE TN
37921-5718
US

IV. Provider business mailing address

911 SHALIMAR POINT DR
SHALIMAR FL
32579-1653
US

V. Phone/Fax

Practice location:
  • Phone: 865-544-0406
  • Fax: 865-544-0480
Mailing address:
  • Phone: 865-209-4987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9117238
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: