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General NPI Number Information
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NPI Number | 1619974573
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Entity Type | Organization
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Legal Business Name | KNOXVILLE DERMATOPATHOLOGY LABORATORY LLC
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Dates
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Enumeration Date | 07/06/2005
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 6400 PINECREST DR STE 200B
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City | PLANO
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State | TX
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Zip | 75024-2960
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Country | US
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Telephone | 865-584-1984
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Fax |
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Provider Business Mailing Address
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Address Line | 6400 PINECREST DR STE 200
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City | PLANO
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State | TX
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Zip | 75024-2962
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Country | US
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Telephone | 865-584-1933
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Fax | 865-584-1323
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Authorized Official
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Title or Position | CEO
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Name | MARC INGRAM
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Credential |
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Telephone | 502-876-9667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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