Healthcare Provider Details

I. General information

NPI: 1578961967
Provider Name (Legal Business Name): ROBERT SHAUN AUSTIN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2014
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 PARKSIDE DR PHYSICIANS PLAZA I, SUITE 209
KNOXVILLE TN
37934-1979
US

IV. Provider business mailing address

10810 PARKSIDE DR PHYSICIANS PLAZA I, SUITE 209
KNOXVILLE TN
37934-1979
US

V. Phone/Fax

Practice location:
  • Phone: 865-251-3030
  • Fax: 865-966-0191
Mailing address:
  • Phone: 865-251-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2700
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2700
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: