Healthcare Provider Details

I. General information

NPI: 1336950930
Provider Name (Legal Business Name): SAMUEL REECE PARROTT PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9352 PARK WEST BLVD
KNOXVILLE TN
37923-4325
US

IV. Provider business mailing address

180 WATERVIEW DR APT 612
OAK RIDGE TN
37830-9064
US

V. Phone/Fax

Practice location:
  • Phone: 865-373-1000
  • Fax:
Mailing address:
  • Phone: 865-308-0134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6373
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: