Healthcare Provider Details

I. General information

NPI: 1154016954
Provider Name (Legal Business Name): BITA IMAM DO, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7744 CONNER RD
POWELL TN
37849-3509
US

IV. Provider business mailing address

1275 DICK LONAS RD UNIT 101
KNOXVILLE TN
37909-1383
US

V. Phone/Fax

Practice location:
  • Phone: 865-546-9751
  • Fax: 833-908-2167
Mailing address:
  • Phone: 865-584-4747
  • Fax: 865-381-1509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number6799
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: