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NPI Code Detail

MEDICARE: DONALD R DOUGLAS PA

MEDICARE: DONALD R DOUGLAS PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA0000000766TN

General Provider Information

NPI Number : 1447301932
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONALD R DOUGLAS PA
Provider Business Mailing Address
First Line : 10321 KINGSTON PIKE
Second Line :
City : KNOXVILLE
State : TN
Zip : 37922-3224
Country : US
Telephone Number : 865-584-3565
Fax Number : 865-584-2956
Provider Business Practice Location Address
First Line : 10321 KINGSTON PIKE
Second Line :
City : KNOXVILLE
State : TN
Zip : 37922-3224
Country : US
Telephone Number : 865-584-3565
Fax Number : 865-584-2956
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2007
Last Update Date : 12/27/2010

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Directions to “ DONALD R DOUGLAS PA” Practice Location

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