Provider Demographics
NPI:1407873284
Name:DERMATOLOGY ASSOCIATES OF KNOXVILLE, PC
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF KNOXVILLE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:PRIMKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-524-2547
Mailing Address - Street 1:939 E EMERALD AVE
Mailing Address - Street 2:SUITE 705
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-4540
Mailing Address - Country:US
Mailing Address - Phone:865-524-2547
Mailing Address - Fax:865-524-0224
Practice Address - Street 1:939 E EMERALD AVE
Practice Address - Street 2:SUITE 705
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-4540
Practice Address - Country:US
Practice Address - Phone:865-524-2547
Practice Address - Fax:865-524-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3387698Medicare ID - Type Unspecified
TN3387697Medicare ID - Type UnspecifiedMEDICARE GROUP