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General NPI Number Information
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NPI Number | 1104900612
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Entity Type | Organization
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Legal Business Name | TOTAL HEALTH
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 7259 OAK RIDGE HIGHWAY
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City | KNOXVILLE
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State | TN
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Zip | 37931
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Country | US
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Telephone | 865-691-8822
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Fax | 865-691-7653
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Provider Business Mailing Address
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Address Line | 7259 OAK RIDGE HIGHWAY
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City | KNOXVILLE
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State | TN
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Zip | 37931
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Country | US
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Telephone | 865-691-8822
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Fax | 865-691-7653
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Authorized Official
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Title or Position | OWNER
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Name | DR. JERRY MICHAEL GORDON
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Credential | DPH
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Telephone | 865-691-8822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0000004232
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License Number State | TN
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