=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962557264
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NORMAN CLIFFORD WALTON M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1924 ALCOA HWY UNIV OF TN MEMORIAL HOSPITAL- DEPT OF MEDICINE
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37920-1511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-544-9340
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5416 HOLSTON HILLS RD
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37914-5130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-637-8918
-----------------------------------------------------
Fax | 865-637-8274
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 20264
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------