Healthcare Provider Details

I. General information

NPI: 1851755672
Provider Name (Legal Business Name): TYLER R WOODALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 MEDICAL PARK DR STE 100
LENOIR CITY TN
37772-5641
US

IV. Provider business mailing address

423 MEDICAL PARK DR STE 100
LENOIR CITY TN
37772-5641
US

V. Phone/Fax

Practice location:
  • Phone: 865-271-6600
  • Fax: 865-374-2102
Mailing address:
  • Phone: 865-271-6600
  • Fax: 865-374-2102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number67627
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: