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General NPI Number Information
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NPI Number | 1316118714
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Entity Type | Organization
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Legal Business Name | PEDIATRIC CONSULTANTS AT CEDAR BLUFF
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 11/01/2017
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Provider Practice Location Address
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Address Line | 9333 PARK WEST BLVD STE 104
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City | KNOXVILLE
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State | TN
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Zip | 37923-4305
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Country | US
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Telephone | 865-560-8778
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Fax | 865-394-6599
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Provider Business Mailing Address
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Address Line | DEPT 888214
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City | KNOXVILLE
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State | TN
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Zip | 37995-8214
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Country | US
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Telephone | 865-670-6199
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Fax | 865-670-6198
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Authorized Official
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Title or Position | MANAGER
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Name | TONYA OWENS
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Credential |
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Telephone | 865-560-8778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | TN
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