Provider Demographics
NPI:1235162298
Name:PEDIATRIC OTOLARYNGOLOGY HEAD AND NECK SURGERY,PLLC
Entity Type:Organization
Organization Name:PEDIATRIC OTOLARYNGOLOGY HEAD AND NECK SURGERY,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-521-6005
Mailing Address - Street 1:2100 W CLINCH AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-2219
Mailing Address - Country:US
Mailing Address - Phone:865-521-6005
Mailing Address - Fax:865-521-6088
Practice Address - Street 1:2100 W CLINCH AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2219
Practice Address - Country:US
Practice Address - Phone:865-521-6005
Practice Address - Fax:865-521-6088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric OtolaryngologyGroup - Single Specialty