Provider Demographics
NPI:1093769457
Name:KNOXVILLE INFECTIOUS DISEASE CONSULTANTS, P.C.
Entity Type:Organization
Organization Name:KNOXVILLE INFECTIOUS DISEASE CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFRY
Authorized Official - Middle Name:T
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-525-4333
Mailing Address - Street 1:2210 SUTHERLAND AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-2337
Mailing Address - Country:US
Mailing Address - Phone:865-525-4333
Mailing Address - Fax:865-212-8879
Practice Address - Street 1:2210 SUTHERLAND AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-2337
Practice Address - Country:US
Practice Address - Phone:865-525-4333
Practice Address - Fax:865-212-8879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3721924Medicare ID - Type Unspecified