Provider Demographics
NPI:1720003338
Name:KNOXVILLE NEUROLOGY SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:KNOXVILLE NEUROLOGY SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-212-6400
Mailing Address - Street 1:PO BOX 415000-MSC410398
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37241-5000
Mailing Address - Country:US
Mailing Address - Phone:865-546-0157
Mailing Address - Fax:865-546-6144
Practice Address - Street 1:501 20TH ST
Practice Address - Street 2:SUITE 505
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1809
Practice Address - Country:US
Practice Address - Phone:865-546-0157
Practice Address - Fax:865-546-6144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3721878Medicare ID - Type Unspecified