Healthcare Provider Details

I. General information

NPI: 1578647806
Provider Name (Legal Business Name): GREATER KNOXVILLE EAR, NOSE AND THROAT ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7557A DANNAHER DRIVE SUITE 210
POWELL TN
37849-3558
US

IV. Provider business mailing address

7557A DANNAHER DR SUITE 210
POWELL TN
37849-3558
US

V. Phone/Fax

Practice location:
  • Phone: 865-521-8050
  • Fax: 865-544-5816
Mailing address:
  • Phone: 865-521-8050
  • Fax: 865-544-5816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALLAN M ROSENBAUM
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 865-521-8050