Healthcare Provider Details

I. General information

NPI: 1043432511
Provider Name (Legal Business Name): PROFESSIONAL DRIVERS MEDICAL DEPOTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13060 PALESTINE LANE
KNOXVILLE TN
37934
US

IV. Provider business mailing address

9135 MIDDLEBROOK PIKE
KNOXVILLE TN
37923-1425
US

V. Phone/Fax

Practice location:
  • Phone: 865-558-3038
  • Fax:
Mailing address:
  • Phone: 865-558-3038
  • Fax: 865-558-3515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BILL BUZZBEE
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 865-558-3038