Provider Demographics
NPI:1265457113
Name:FACULTY INTERNAL MEDICINE, PLLC
Entity Type:Organization
Organization Name:FACULTY INTERNAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:ELY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-288-1548
Mailing Address - Street 1:11440 PARKSIDE DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2658
Mailing Address - Country:US
Mailing Address - Phone:865-288-1548
Mailing Address - Fax:865-377-1002
Practice Address - Street 1:11440 PARKSIDE DR
Practice Address - Street 2:SUITE 302
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-2658
Practice Address - Country:US
Practice Address - Phone:865-288-1548
Practice Address - Fax:865-377-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3723629Medicare ID - Type Unspecified