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General NPI Number Information
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NPI Number | 1972084069
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Entity Type | Organization
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Legal Business Name | EDMUNDS GASTROENTEROLOGY, PLLC
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 08/09/2021
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Provider Practice Location Address
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Address Line | 4713 PAPERMILL DR
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City | KNOXVILLE
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State | TN
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Zip | 37909-1908
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Country | US
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Telephone | 865-851-7771
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Fax | 865-851-7835
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Provider Business Mailing Address
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Address Line | 4713 PAPERMILL DR STE 100
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City | KNOXVILLE
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State | TN
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Zip | 37909-1924
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Country | US
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Telephone | 865-851-7771
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Fax | 865-851-7835
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | PAT JENKINS
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Credential |
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Telephone | 865-740-1095
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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 | MD26426
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License Number State | TN
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