Healthcare Provider Details

I. General information

NPI: 1003275132
Provider Name (Legal Business Name): MICHAEL PATRICK FLYNN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 20TH ST STE 503
KNOXVILLE TN
37916-1832
US

IV. Provider business mailing address

501 20TH ST STE 503
KNOXVILLE TN
37916-1832
US

V. Phone/Fax

Practice location:
  • Phone: 865-331-4321
  • Fax: 865-331-4320
Mailing address:
  • Phone: 865-331-4321
  • Fax: 865-374-2078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2978
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: