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General NPI Number Information
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NPI Number | 1699972901
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Entity Type | Organization
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Legal Business Name | KNOXVILLE CONSULTANTS IN GASTROENTEROLOGY PC
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 09/11/2007
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Provider Practice Location Address
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Address Line | 9349 PARK WEST BLVD SUITE 202
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City | KNOXVILLE
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State | TN
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Zip | 37923-4306
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Country | US
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Telephone | 865-531-8294
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Fax |
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Provider Business Mailing Address
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Address Line | 9349 PARK WEST BLVD SUITE 202
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City | KNOXVILLE
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State | TN
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Zip | 37923-4306
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Country | US
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Telephone | 865-531-8294
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | PATRICIA CONLEY
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Credential |
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Telephone | 865-531-8294
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MD018257
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MD008974
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License Number State | TN
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