Healthcare Provider Details

I. General information

NPI: 1598148736
Provider Name (Legal Business Name): KNOXVILLE ENDOCRINOLOGY CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 LOVELL RD
KNOXVILLE TN
37934-1903
US

IV. Provider business mailing address

108 LOVELL RD
KNOXVILLE TN
37934-1903
US

V. Phone/Fax

Practice location:
  • Phone: 865-288-7776
  • Fax: 865-288-7775
Mailing address:
  • Phone: 865-288-7776
  • Fax: 865-288-7775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMD0000038206
License Number StateTN

VIII. Authorized Official

Name: HASSAN FOUAD NADROUS
Title or Position: OWNER
Credential: MD
Phone: 865-986-9151