Provider Demographics
NPI:1255300356
Name:JETHANANDANI, ARUN (MD)
Entity Type:Individual
Prefix:DR
First Name:ARUN
Middle Name:
Last Name:JETHANANDANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 SUTHERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-2355
Mailing Address - Country:US
Mailing Address - Phone:865-523-8695
Mailing Address - Fax:865-523-6827
Practice Address - Street 1:5310 BALL CAMP PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-3234
Practice Address - Country:US
Practice Address - Phone:865-523-4704
Practice Address - Fax:865-602-2387
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN196752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3047537Medicaid
TN3047537Medicaid