MEDICARE: UNIVERSITY OF TENNESSEE

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	170100000X	Ph.D. Medical Genetics

General Provider Information

NPI Number	:	1518037183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF TENNESSEE

Provider Business Mailing Address
First Line	:	1930 ALCOA HWY STE 435
Second Line	:	UT GENETICS CENTER
City	:	KNOXVILLE
State	:	TN
Zip	:	37920-1520
Country	:	US
Telephone Number	:	865-544-9030
Fax Number	:	865-544-6675

Provider Business Practice Location Address
First Line	:	1930 ALCOA HWY STE 435
Second Line	:	UT GENETICS CENTER
City	:	KNOXVILLE
State	:	TN
Zip	:	37920-1520
Country	:	US
Telephone Number	:	865-544-9030
Fax Number	:	865-544-6675

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. KARLA J MATTESON
Credential	:	PH.D.
Telephone Number	:	865-544-9449

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	08/22/2020

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Directions to “UNIVERSITY OF TENNESSEE ” Practice Location

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