Provider Demographics
NPI:1568759629
Name:NEW VISION FELLOWSHIP
Entity Type:Organization
Organization Name:NEW VISION FELLOWSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDI
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-357-0488
Mailing Address - Street 1:5745 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921-2225
Mailing Address - Country:US
Mailing Address - Phone:865-357-0488
Mailing Address - Fax:
Practice Address - Street 1:5745 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-2225
Practice Address - Country:US
Practice Address - Phone:865-357-0488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care