Healthcare Provider Details

I. General information

NPI: 1003230236
Provider Name (Legal Business Name): APP OF TENNESSEE ED, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 E LAMAR ALEXANDER PKWY
MARYVILLE TN
37804
US

IV. Provider business mailing address

PO BOX 31957
CLARKSVILLE TN
37040-0033
US

V. Phone/Fax

Practice location:
  • Phone: 865-983-7211
  • Fax:
Mailing address:
  • Phone:
  • Fax: 205-313-5245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JAMES GRIMES
Title or Position: CFO
Credential:
Phone: 615-551-6611