MEDICARE: JUSTIN ROBERT CECIL PA-C

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
1	363AM0700X	Medical Physician Assistant	1552	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487834107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN ROBERT CECIL PA-C

Provider Business Mailing Address
First Line	:	1225 E WEISGARBER RD
Second Line	:	SUITE 200
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-2604
Country	:	US
Telephone Number	:	865-584-4747
Fax Number	:	865-584-1363

Provider Business Practice Location Address
First Line	:	721 HIGHWAY 321 N STE C
Second Line	:
City	:	LENOIR CITY
State	:	TN
Zip	:	37771-5003
Country	:	US
Telephone Number	:	865-986-3283
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2007
Last Update Date	:	11/29/2017

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