Healthcare Provider Details

I. General information

NPI: 1063073286
Provider Name (Legal Business Name): EAST TOWN HEALTH AND WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 MILLERTOWN PIKE
KNOXVILLE TN
37917-2138
US

IV. Provider business mailing address

4800 MILLERTOWN PIKE
KNOXVILLE TN
37917-2138
US

V. Phone/Fax

Practice location:
  • Phone: 865-522-6300
  • Fax: 865-522-2455
Mailing address:
  • Phone: 865-522-6300
  • Fax: 865-522-2455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JUDITH P ROY
Title or Position: OWNER
Credential: DC
Phone: 865-522-6300