=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699076117
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DUSTIN L BATES P.A.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2010
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11408 KINGSTON PIKE STE 400
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37934-3976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-392-1888
-----------------------------------------------------
Fax | 865-392-1889
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11408 KINGSTON PIKE STE 400
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37934-3976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-392-1888
-----------------------------------------------------
Fax | 865-392-1889
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA0000003166
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------