MEDICARE: NEW VISION FELLOWSHIP

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	261QA0600X	Adult Day Care Clinic/Center		TN

General Provider Information

NPI Number	:	1568759629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW VISION FELLOWSHIP

Provider Business Mailing Address
First Line	:	5745 WESTERN AVE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37921-2225
Country	:	US
Telephone Number	:	865-357-0488
Fax Number	:

Provider Business Practice Location Address
First Line	:	5745 WESTERN AVE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37921-2225
Country	:	US
Telephone Number	:	865-357-0488
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. JUDI PARRIS
Credential	:
Telephone Number	:	865-357-0488

Provider Enumeration Date	:	07/08/2011
Last Update Date	:	07/08/2011

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Directions to “NEW VISION FELLOWSHIP ” Practice Location

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