MEDICARE: DR. KATHLEEN O'CONNOR EDMUNDS MD

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	207V00000X	Obstetrics & Gynecology Physician	26543	TN

General Provider Information

NPI Number	:	1972579662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN O'CONNOR EDMUNDS MD

Provider Business Mailing Address
First Line	:	1636 BICKERSTAFF BLVD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-8053
Country	:	US
Telephone Number	:	865-684-1766
Fax Number	:	865-684-1767

Provider Business Practice Location Address
First Line	:	930 E EMERALD AVE
Second Line	:	SUITE 712
City	:	KNOXVILLE
State	:	TN
Zip	:	37917-4539
Country	:	US
Telephone Number	:	865-684-1766
Fax Number	:	865-684-1767

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	07/08/2007

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