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General NPI Number Information
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NPI Number | 1417140070
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Entity Type | Organization
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Legal Business Name | TIMOTHY L. GARDNER,DPM
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Dates
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Enumeration Date | 08/27/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 10810 PARKSIDE DR STE 202
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City | KNOXVILLE
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State | TN
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Zip | 37934-1981
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Country | US
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Telephone | 865-218-7474
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Fax | 865-218-7475
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Provider Business Mailing Address
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Address Line | 10810 PARKSIDE DR STE 202
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City | KNOXVILLE
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State | TN
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Zip | 37934-1981
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Country | US
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Telephone | 865-218-7474
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Fax | 865-218-7475
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY LOGAN GARDNER
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Credential | DPM
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Telephone | 865-218-7474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | DPM409
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License Number State | TN
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