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General NPI Number Information
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NPI Number | 1760717896
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Entity Type | Organization
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Legal Business Name | TENNESSEE CANCER SPECIALISTS PLLC
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Dates
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Enumeration Date | 10/07/2009
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Last Update Date | 06/21/2016
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Provider Practice Location Address
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Address Line | 1415 OLD WEISGARBER RD STE 200
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City | KNOXVILLE
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State | TN
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Zip | 37909-1341
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Country | US
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Telephone | 865-934-5806
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Fax | 865-934-5816
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Provider Business Mailing Address
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Address Line | 900 E HILL AVE SUITE 230
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City | KNOXVILLE
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State | TN
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Zip | 37915-2566
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Country | US
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Telephone | 865-862-0998
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Fax | 865-544-1861
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Authorized Official
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Title or Position | CHIEF MANAGER PHYSICIAN
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Name | MITCHELL MARTIN
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Credential | MD
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Telephone | 865-637-9330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 4721
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License Number State | TN
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