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General NPI Number Information
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NPI Number | 1043503964
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Entity Type | Organization
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Legal Business Name | MEDICAL INTERACTIVE EDUCATION, LLC
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Dates
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Enumeration Date | 05/25/2011
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Last Update Date | 05/25/2011
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Provider Practice Location Address
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Address Line | 106 W. SUMMIT HILL DR. SUITE 301
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City | KNOXVILLE
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State | TN
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Zip | 37902-1041
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Country | US
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Telephone | 865-599-4409
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Fax | 865-546-5034
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Provider Business Mailing Address
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Address Line | 106 W. SUMMIT HILL DR. SUITE 301
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City | KNOXVILLE
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State | TN
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Zip | 37902-1041
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Country | US
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Telephone | 865-599-4409
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Fax | 865-546-5034
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. JOHN DOUGHERTY JR.
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Credential | M.D.
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Telephone | 865-599-4409
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 8309
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License Number State | TN
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