Provider Demographics
NPI:1245782903
Name:HEALTHCARE OF KNOXVILLE
Entity Type:Organization
Organization Name:HEALTHCARE OF KNOXVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:DANTULURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-816-6306
Mailing Address - Street 1:4320 BALL CAMP PIKE
Mailing Address - Street 2:SUITE B
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921-3312
Mailing Address - Country:US
Mailing Address - Phone:865-816-6306
Mailing Address - Fax:
Practice Address - Street 1:4320 BALL CAMP PIKE
Practice Address - Street 2:SUITE B
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-3312
Practice Address - Country:US
Practice Address - Phone:865-816-6306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty