Healthcare Provider Details

I. General information

NPI: 1083682579
Provider Name (Legal Business Name): ADAM PATRICK BUZZERD PA C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ADAM P BUZZERD

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 PARKSIDE DR STE 208
KNOXVILLE TN
37934-1981
US

IV. Provider business mailing address

10810 PARKSIDE DR STE 208
KNOXVILLE TN
37934-1981
US

V. Phone/Fax

Practice location:
  • Phone: 865-647-3350
  • Fax: 865-647-3359
Mailing address:
  • Phone: 865-647-3350
  • Fax: 865-647-3359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9103471
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA1919
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: