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General NPI Number Information
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NPI Number | 1679648398
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Entity Type | Individual
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Provider Name | EMERSON JAY MOUNGER MD MEDICAL DOCTOR
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Gender | Male
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 12/29/2009
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Provider Practice Location Address
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Address Line | 1932 ALCOA HWY SUITE C 475
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City | KNOXVILLE
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State | TN
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Zip | 37920-1523
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Country | US
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Telephone | 865-305-5000
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Fax | 865-305-5001
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Provider Business Mailing Address
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Address Line | 1932 ALCOA HWY SUITE 475 BUILDING C
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City | KNOXVILLE
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State | TN
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Zip | 37920-1523
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Country | US
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Telephone | 865-305-5000
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Fax | 865-305-5001
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | MD0000004719
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License Number State | TN
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