MEDICARE: GENESIS NEUROSCIENCE CLINIC LLC

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	207QG0300X	Geriatric Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1700497302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS NEUROSCIENCE CLINIC LLC

Provider Business Mailing Address
First Line	:	PO BOX 10367
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37939-0367
Country	:	US
Telephone Number	:	865-584-7376
Fax Number	:	865-540-3856

Provider Business Practice Location Address
First Line	:	1400 DOWELL SPRINGS BLVD STE 340
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-2445
Country	:	US
Telephone Number	:	865-584-7376
Fax Number	:	865-444-7672

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. MONICA K. CRANE
Credential	:	MD
Telephone Number	:	865-888-9494

Provider Enumeration Date	:	08/17/2020
Last Update Date	:	06/16/2025

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