Provider Demographics
NPI:1245420363
Name:NEUROLOGICAL & SPINESURGERY OF TENNESSEE
Entity Type:Organization
Organization Name:NEUROLOGICAL & SPINESURGERY OF TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-670-9501
Mailing Address - Street 1:9333 PARK WEST BLVD
Mailing Address - Street 2:STE 104
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4341
Mailing Address - Country:US
Mailing Address - Phone:865-670-9501
Mailing Address - Fax:865-670-9573
Practice Address - Street 1:9333 PARK WEST BLVD
Practice Address - Street 2:STE 104
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4341
Practice Address - Country:US
Practice Address - Phone:865-670-9501
Practice Address - Fax:865-670-9573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000024313207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3000622OtherMEDICARE