Provider Demographics
NPI:1366847006
Name:GOTT FAMILY MEDICAL CLINIC, LLC
Entity Type:Organization
Organization Name:GOTT FAMILY MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MSN, FNP/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:GOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, FNP
Authorized Official - Phone:865-312-9586
Mailing Address - Street 1:10404 JACKSON OAKS WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3293
Mailing Address - Country:US
Mailing Address - Phone:865-312-9586
Mailing Address - Fax:
Practice Address - Street 1:10404 JACKSON OAKS WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3293
Practice Address - Country:US
Practice Address - Phone:865-312-9586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13526363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty