Healthcare Provider Details

I. General information

NPI: 1730468182
Provider Name (Legal Business Name): COVENANT MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 MEDICAL PARK DR STE 100
LENOIR CITY TN
37772-5640
US

IV. Provider business mailing address

1400 CENTERPOINT BLVD BLDG A, STE 202
KNOXVILLE TN
37932-1979
US

V. Phone/Fax

Practice location:
  • Phone: 865-271-6575
  • Fax: 865-986-7807
Mailing address:
  • Phone: 865-374-5200
  • Fax: 865-374-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. JULIE G UTTERBACK
Title or Position: VP FINANCIAL SERVICES
Credential:
Phone: 865-374-5119