Provider Demographics
NPI:1093788044
Name:CROSS, THEA (MD)
Entity Type:Individual
Prefix:DR
First Name:THEA
Middle Name:
Last Name:CROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 FORT SANDERS WEST BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3394
Mailing Address - Country:US
Mailing Address - Phone:865-531-5350
Mailing Address - Fax:865-374-2125
Practice Address - Street 1:220 FORT SANDERS WEST BLVD STE 300
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922
Practice Address - Country:US
Practice Address - Phone:865-531-5350
Practice Address - Fax:865-374-2125
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN373892084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3885091OtherMEDICARE
TNQ018071Medicaid
TNP00378728Medicare PIN
TNQ018071Medicaid
TN3885093Medicare PIN
TN103I869658Medicare PIN