Provider Demographics
NPI:1023013307
Name:ROUSSIS, PERICLIS (MD)
Entity Type:Individual
Prefix:DR
First Name:PERICLIS
Middle Name:
Last Name:ROUSSIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 19TH ST.
Mailing Address - Street 2:SUITE 401
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1839
Mailing Address - Country:US
Mailing Address - Phone:865-331-2020
Mailing Address - Fax:865-331-2019
Practice Address - Street 1:501 19TH ST.
Practice Address - Street 2:SUITE 401
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1839
Practice Address - Country:US
Practice Address - Phone:865-331-2020
Practice Address - Fax:865-331-2019
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD18681207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3033722Medicaid
TN4061072OtherBCBS
C36404Medicare UPIN
TN3033722Medicaid