Healthcare Provider Details

I. General information

NPI: 1366547879
Provider Name (Legal Business Name): KATHY CARTWRIGHT PHILYAW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 SOUTH CEDAR AVENUE SUITE 1
SOUTH PITTSBURG TN
37380-1305
US

IV. Provider business mailing address

325 SOUTH CEDAR AVENUE SUITE 1
SOUTH PITTSBURG TN
37380-1305
US

V. Phone/Fax

Practice location:
  • Phone: 423-228-4159
  • Fax:
Mailing address:
  • Phone: 423-228-4159
  • Fax: 423-228-4146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30360
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: