Healthcare Provider Details

I. General information

NPI: 1427382050
Provider Name (Legal Business Name): CARLOS LUCIO GALLI B.B.A.,ONDAMED CERT.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 09/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 MARKET PLACE BLVD
KNOXVILLE TN
37922-2347
US

IV. Provider business mailing address

508 JUNCO LN
KNOXVILLE TN
37934-4742
US

V. Phone/Fax

Practice location:
  • Phone: 865-556-1244
  • Fax:
Mailing address:
  • Phone: 865-966-2203
  • Fax: 865-966-2203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: