=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255428231
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDWARD ALVA WORKMAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2006
-----------------------------------------------------
Last Update Date | 06/29/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 PERIMETER PARK RD STE C
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37922-2200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-862-0763
-----------------------------------------------------
Fax | 865-862-0764
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 PERIMETER PARK RD STE C
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37922-2200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-862-0763
-----------------------------------------------------
Fax | 865-862-0764
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 19179
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------