Healthcare Provider Details

I. General information

NPI: 1619893971
Provider Name (Legal Business Name): IVAN N COOPER, DPM, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 TOWN CREEK RD E STE 3
LENOIR CITY TN
37772-5690
US

IV. Provider business mailing address

125 TOWN CREEK RD E STE 3
LENOIR CITY TN
37772-5690
US

V. Phone/Fax

Practice location:
  • Phone: 865-632-5700
  • Fax: 865-632-5778
Mailing address:
  • Phone: 865-632-5700
  • Fax: 865-632-5778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DONNA ELLIS
Title or Position: BILLING MANAGER
Credential:
Phone: 865-632-5700