Healthcare Provider Details

I. General information

NPI: 1154720662
Provider Name (Legal Business Name): DISCOVER DIAGNOSTIC LABORATORY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 S ILLINOIS AVE SUITE B-104
OAK RIDGE TN
37830-7908
US

IV. Provider business mailing address

702 S ILLINOIS AVE SUITE B-104
OAK RIDGE TN
37830-7908
US

V. Phone/Fax

Practice location:
  • Phone: 855-314-3337
  • Fax: 888-965-6670
Mailing address:
  • Phone: 855-314-3337
  • Fax: 888-965-6670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JOHN COFFMAN
Title or Position: CEO
Credential:
Phone: 865-257-0569