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General NPI Number Information
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NPI Number | 1508977661
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Entity Type | Organization
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Legal Business Name | WEST KNOXVILLE NEUROLOGICAL ASSOCIATE
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/13/2011
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Provider Practice Location Address
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Address Line | 300 PROSPERITY RD STE 103
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City | KNOXVILLE
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State | TN
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Zip | 37923-4717
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Country | US
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Telephone | 865-769-9595
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Fax | 865-769-9510
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Provider Business Mailing Address
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Address Line | 300 PROSPERITY RD STE 103
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City | KNOXVILLE
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State | TN
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Zip | 37923-4717
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Country | US
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Telephone | 865-769-9595
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Fax | 865-769-9510
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Authorized Official
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Title or Position | BILLING
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Name | ROBERTA R CLASSEN
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Credential |
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Telephone | 843-810-1260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD 11457
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License Number State | TN
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