=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073940839
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KNOXVILLE HEALTH AND WELLNESS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2013
-----------------------------------------------------
Last Update Date | 01/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2902 TAZEWELL PIKE STE A
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37918-1877
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-688-3000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2902 TAZEWELL PIKE STE A
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37918-1877
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-688-3008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | REBECCA RUSSELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 865-688-3000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------