Provider Demographics
NPI:1205857430
Name:EAST TENNESSEE REGIONAL OB/GYN ASSOCIATES PC
Entity Type:Organization
Organization Name:EAST TENNESSEE REGIONAL OB/GYN ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:TATUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-522-0365
Mailing Address - Street 1:939 EMERALD AVE
Mailing Address - Street 2:SUITE 805
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-4502
Mailing Address - Country:US
Mailing Address - Phone:865-522-0365
Mailing Address - Fax:865-971-6809
Practice Address - Street 1:939 EMERALD AVE
Practice Address - Street 2:SUITE 805
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-4502
Practice Address - Country:US
Practice Address - Phone:865-522-0365
Practice Address - Fax:865-971-6809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD014732207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherTAX ID NUMBER