Healthcare Provider Details

I. General information

NPI: 1649440348
Provider Name (Legal Business Name): CRESCENT HEALTH GATLINBURG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 COMMUNITY CENTER DR SUITE 103
PIGEON FORGE TN
37863-6251
US

IV. Provider business mailing address

190 COMMUNITY CENTER DR SUITE 103
PIGEON FORGE TN
37863-6251
US

V. Phone/Fax

Practice location:
  • Phone: 865-446-4032
  • Fax: 865-868-4746
Mailing address:
  • Phone: 865-446-4032
  • Fax: 865-868-4746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberTN0250
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTN5198
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTN8475
License Number StateTN

VIII. Authorized Official

Name: RHONDA D DAVIS
Title or Position: GENERAL MANAGER
Credential: GM
Phone: 865-446-4032