=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780676429
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHDC OF KNOXVILLE, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2005
-----------------------------------------------------
Last Update Date | 04/22/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 W OLDHAM AVE
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37921-2747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-522-1244
-----------------------------------------------------
Fax | 865-525-7041
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 W OLDHAM AVE
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37921-2747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-522-1244
-----------------------------------------------------
Fax | 865-525-7041
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE ADMINISTRATOR
-----------------------------------------------------
Name | MISS SHERRIE H WILLIAMS
-----------------------------------------------------
Credential | RDA
-----------------------------------------------------
Telephone | 865-522-1244
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------