Provider Demographics
NPI:1497073928
Name:MOINUDDIN, AZMAT
Entity Type:Individual
Prefix:MRS
First Name:AZMAT
Middle Name:
Last Name:MOINUDDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 MELFORD LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-5289
Mailing Address - Country:US
Mailing Address - Phone:865-219-3937
Mailing Address - Fax:865-338-5383
Practice Address - Street 1:9041 EXECUTIVE PARK DR STE 275B
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4621
Practice Address - Country:US
Practice Address - Phone:865-384-7476
Practice Address - Fax:865-338-5383
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC 2769101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1526602Medicaid