Healthcare Provider Details
I. General information
NPI: 1396767885
Provider Name (Legal Business Name): TOTS & TEENS PEDIATRICS,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/24/2006
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
7557A DANNAHER DRIVE SUITE 130
POWELL TN
37849-3568
US
IV. Provider business mailing address
7557B DANNAHER WAY SUITE G45
POWELL TN
37849-3568
US
V. Phone/Fax
- Phone: 865-512-1180
- Fax: 865-512-1185
- Phone: 865-512-1180
- Fax: 865-512-1185
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
NEIL
FELD
Title or Position: OWNER
Credential: M.D.
Phone: 865-512-1180