Provider Demographics
NPI:1104398791
Name:EAST TENNESSEE PHYSICIANS LLC
Entity Type:Organization
Organization Name:EAST TENNESSEE PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZGIET
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:865-771-0205
Mailing Address - Street 1:505 MOREVIEW LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-7082
Mailing Address - Country:US
Mailing Address - Phone:865-771-0205
Mailing Address - Fax:
Practice Address - Street 1:5917 RUTLEDGE PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37924-2252
Practice Address - Country:US
Practice Address - Phone:865-321-1410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty