Provider Demographics
NPI:1659084572
Name:MAXWELL-DAVIS, BRODRIEKA NIWANDE
Entity Type:Individual
Prefix:
First Name:BRODRIEKA
Middle Name:NIWANDE
Last Name:MAXWELL-DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DRIEKA
Other - Middle Name:
Other - Last Name:MAXWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 TECH CENTER DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912-2747
Mailing Address - Country:US
Mailing Address - Phone:865-637-9711
Mailing Address - Fax:
Practice Address - Street 1:2455 SUTHERLAND AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-2355
Practice Address - Country:US
Practice Address - Phone:865-637-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker