Healthcare Provider Details

I. General information

NPI: 1578956710
Provider Name (Legal Business Name): HOUSECALL PRIMARY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 06/27/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 E LAMAR ALEXANDER PKWY
MARYVILLE TN
37804-5283
US

IV. Provider business mailing address

PO BOX 5777
MARYVILLE TN
37802-5777
US

V. Phone/Fax

Practice location:
  • Phone: 865-980-5200
  • Fax: 865-246-2106
Mailing address:
  • Phone: 865-246-2104
  • Fax: 865-246-2106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateTN

VIII. Authorized Official

Name: DR. DEAVER T SHATTUCK
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 865-246-2104