Healthcare Provider Details

I. General information

NPI: 1831355833
Provider Name (Legal Business Name): JEREMIAH N. BIVINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N WEISGARBER RD SUITE 200
KNOXVILLE TN
37909-2706
US

IV. Provider business mailing address

6701 BAUM DR SUITE 140
KNOXVILLE TN
37919-7360
US

V. Phone/Fax

Practice location:
  • Phone: 865-584-8588
  • Fax: 865-584-3364
Mailing address:
  • Phone: 865-584-5727
  • Fax: 865-450-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number45398
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number069545
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: