Provider Demographics
NPI:1205830171
Name:MAHLOW, WILLIAM JEREMY (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JEREMY
Last Name:MAHLOW
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 1:1940 ALCOA HWY
Mailing Address - Street 2:SUITE E 310
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-2244
Mailing Address - Country:US
Mailing Address - Phone:865-387-1585
Mailing Address - Fax:
Practice Address - Street 1:1940 ALCOA HWY
Practice Address - Street 2:SUITE E 310
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-2244
Practice Address - Country:US
Practice Address - Phone:865-544-2800
Practice Address - Fax:865-544-6812
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36410207R00000X, 174400000X, 207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH84815Medicare UPIN