Healthcare Provider Details

I. General information

NPI: 1992940761
Provider Name (Legal Business Name): PEDIATRIC CONSULTANTS OF LENOIR CITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 MEDICAL PARK DRIVE
LENOIR CITY TN
37772-6473
US

IV. Provider business mailing address

303 MEDICAL PARK DRIVE
LENOIR CITY TN
37772-6473
US

V. Phone/Fax

Practice location:
  • Phone: 865-271-9536
  • Fax: 865-986-0212
Mailing address:
  • Phone: 865-271-9536
  • Fax: 865-986-0212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: DR. SUNEETHA MOOSS
Title or Position: MD
Credential: MD
Phone: 865-271-9536