Healthcare Provider Details

I. General information

NPI: 1154442861
Provider Name (Legal Business Name): EAST TENNESSEE VEIN CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1344 DOWELL SPRINGS BLVD
KNOXVILLE TN
37909
US

IV. Provider business mailing address

PO BOX 52333
KNOXVILLE TN
37950-2333
US

V. Phone/Fax

Practice location:
  • Phone: 865-686-0807
  • Fax: 865-357-8346
Mailing address:
  • Phone: 865-686-0807
  • Fax: 865-357-8346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number202K00000X
License Number StateTN

VIII. Authorized Official

Name: DARLA Y WALKER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 865-686-0507