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General NPI Number Information
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NPI Number | 1104398791
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Entity Type | Organization
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Legal Business Name | EAST TENNESSEE PHYSICIANS LLC
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Dates
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Enumeration Date | 12/20/2018
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Last Update Date | 12/20/2018
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Provider Practice Location Address
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Address Line | 5917 RUTLEDGE PIKE
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City | KNOXVILLE
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State | TN
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Zip | 37924-2252
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Country | US
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Telephone | 865-321-1410
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Fax |
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Provider Business Mailing Address
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Address Line | 505 MOREVIEW LN
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City | KNOXVILLE
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State | TN
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Zip | 37934-7082
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Country | US
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Telephone | 865-771-0205
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACKIE ZGIET
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Credential | FNP
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Telephone | 865-771-0205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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