Provider Demographics
NPI:1518037183
Name:UNIVERSITY OF TENNESSEE
Entity Type:Organization
Organization Name:UNIVERSITY OF TENNESSEE
Other - Org Name:UT GENETICS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MATTESON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:865-544-9449
Mailing Address - Street 1:1930 ALCOA HWY STE 435
Mailing Address - Street 2:UT GENETICS CENTER
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1520
Mailing Address - Country:US
Mailing Address - Phone:865-544-9030
Mailing Address - Fax:865-544-6675
Practice Address - Street 1:1930 ALCOA HWY STE 435
Practice Address - Street 2:UT GENETICS CENTER
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1520
Practice Address - Country:US
Practice Address - Phone:865-544-9030
Practice Address - Fax:865-544-6675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3375286Medicare ID - Type Unspecified