Healthcare Provider Details

I. General information

NPI: 1790561413
Provider Name (Legal Business Name): GI FOR KIDS DISPENSARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 TOWN CENTER BLVD
KNOXVILLE TN
37922-6638
US

IV. Provider business mailing address

1975 TOWN CENTER BLVD
KNOXVILLE TN
37922-6638
US

V. Phone/Fax

Practice location:
  • Phone: 865-546-3998
  • Fax: 865-546-1123
Mailing address:
  • Phone: 865-546-3998
  • Fax: 865-546-1123

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: CHRISTI OLIVER
Title or Position: DIRECTOR
Credential: RN
Phone: 865-546-3998