MEDICARE: KNOX COUNTY HEALTH DEPT

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	251K00000X	Public Health or Welfare Agency	LPN0000038059	TN

General Provider Information

NPI Number	:	1578808655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KNOX COUNTY HEALTH DEPT

Provider Business Mailing Address
First Line	:	1028 OLD CEDAR BLUFF RD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-2283
Country	:	US
Telephone Number	:	865-215-5950
Fax Number	:	865-215-5959

Provider Business Practice Location Address
First Line	:	1028 OLD CEDAR BLUFF RD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-2283
Country	:	US
Telephone Number	:	865-215-5950
Fax Number	:	865-215-5959

Authorized Official
Title or Position	:	PUBLIC HEALTH NURSE
Name	:	MISS TAMMIE JO GOTTMAN
Credential	:	LPN
Telephone Number	:	865-215-5950

Provider Enumeration Date	:	11/30/2012
Last Update Date	:	11/30/2012

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