MEDICARE: DR. JUSTIN R. DAGGETT M.D.

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	208000000X	Pediatrics Physician	63568	TN
2	2082S0105X	Surgery of the Hand (Plastic Surgery) Physician	63568	TN
3	208200000X	Plastic Surgery Physician	63568	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982903712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN R. DAGGETT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 15004
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37901-5004
Country	:	US
Telephone Number	:	865-541-8895
Fax Number	:	865-633-4808

Provider Business Practice Location Address
First Line	:	2100 CLINCH AVENUE SUITE 510
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37916-2225
Country	:	US
Telephone Number	:	865-824-4939
Fax Number	:	866-630-2013

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

Provider Enumeration Date	:	03/18/2011
Last Update Date	:	02/14/2025

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