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General NPI Number Information
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NPI Number | 1316792492
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Entity Type | Organization
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Legal Business Name | TENNESSEE RIVER MEDICAL GROUP PC
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 6311 KINGSTON PIKE STE 26W
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City | KNOXVILLE
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State | TN
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Zip | 37919-4900
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Country | US
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Telephone | 865-674-9193
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Fax |
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Provider Business Mailing Address
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Address Line | 6311 KINGSTON PIKE STE 26W
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City | KNOXVILLE
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State | TN
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Zip | 37919-4900
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Country | US
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Telephone | 865-674-9193
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JIMMY D GENTRY II
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Credential | MD
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Telephone | 865-674-9193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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