Provider Demographics
NPI:1316575806
Name:PICKETT, JOSHUA LOGAN
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:LOGAN
Last Name:PICKETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 ALCOA HWY STE 127
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1511
Mailing Address - Country:US
Mailing Address - Phone:865-305-9410
Mailing Address - Fax:865-305-8261
Practice Address - Street 1:11440 PARKSIDE DR STE 302
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-2662
Practice Address - Country:US
Practice Address - Phone:865-218-9220
Practice Address - Fax:865-218-3331
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TNDO5259207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program