Healthcare Provider Details

I. General information

NPI: 1659497394
Provider Name (Legal Business Name): MOHAMMAD BHIDYA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2595 MAYNARDVILLE HWY
MAYNARDVILLE TN
37807
US

IV. Provider business mailing address

PO BOX 117
MAYNARDVILLE TN
37807
US

V. Phone/Fax

Practice location:
  • Phone: 865-992-3000
  • Fax: 865-992-7787
Mailing address:
  • Phone: 865-992-3000
  • Fax: 865-992-7787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD0000025564
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000008234
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000006032
License Number StateTN

VIII. Authorized Official

Name: DR. MOHAMMAD PARVEZ BHIDYA
Title or Position: PRESIDENT SECRETARY MOHAMMAD BHIDYA
Credential: M.D.
Phone: 865-992-3000