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General NPI Number Information
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NPI Number | 1821346107
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Entity Type | Organization
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Legal Business Name | MIDSTATE MEDICAL ASSOCIATES PLLC
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Dates
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Enumeration Date | 08/17/2012
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Last Update Date | 11/04/2013
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Provider Practice Location Address
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Address Line | 116 CONCORD RD STE 400
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City | KNOXVILLE
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State | TN
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Zip | 37934-2940
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Country | US
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Telephone | 865-777-6880
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Fax | 865-777-6881
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Provider Business Mailing Address
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Address Line | PO BOX 437
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City | HARRIMAN
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State | TN
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Zip | 37748-0437
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Country | US
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Telephone | 865-882-2909
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Fax | 865-882-2890
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Authorized Official
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Title or Position | MBR
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Name | ERIC M REDMON
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Credential | MD
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Telephone | 865-560-8787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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