Provider Demographics
NPI:1659581080
Name:ALBERT C.S. EBENEZER, M.D.
Entity Type:Organization
Organization Name:ALBERT C.S. EBENEZER, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT C S
Authorized Official - Middle Name:
Authorized Official - Last Name:EBENEZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-523-0614
Mailing Address - Street 1:2001 LAUREL AVE
Mailing Address - Street 2:NEWLAND PROFESSIONAL BUILDING SUITE 601
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1810
Mailing Address - Country:US
Mailing Address - Phone:865-523-0614
Mailing Address - Fax:865-546-2625
Practice Address - Street 1:2001 LAUREL AVE
Practice Address - Street 2:NEWLAND PROFESSIONAL BUILDING SUITE 601
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1810
Practice Address - Country:US
Practice Address - Phone:865-523-0614
Practice Address - Fax:865-546-2625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7866207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7866OtherMEDICAL LICENSE
TNB02408Medicare UPIN