Healthcare Provider Details

I. General information

NPI: 1720172489
Provider Name (Legal Business Name): TENNESSEE UROLOGY ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9245 PARK WEST BLVD
KNOXVILLE TN
37923-4425
US

IV. Provider business mailing address

25 CROSSROADS DR STE 306
OWINGS MILLS MD
21117-5437
US

V. Phone/Fax

Practice location:
  • Phone: 865-276-2764
  • Fax: 865-694-7621
Mailing address:
  • Phone: 866-953-3111
  • Fax: 443-471-8540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MARY LAUTERBACH
Title or Position: CREDENTIALING
Credential:
Phone: 443-738-2889