Provider Demographics
NPI:1760428387
Name:NOWELL, WALKER EUGENE (DO)
Entity Type:Individual
Prefix:
First Name:WALKER
Middle Name:EUGENE
Last Name:NOWELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 E WEISGARBER RD
Mailing Address - Street 2:STE 100
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2604
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:
Practice Address - Street 1:10215 KINGSTON PIKE
Practice Address - Street 2:STE 100
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3222
Practice Address - Country:US
Practice Address - Phone:865-691-0733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1418207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3307580Medicaid
TNP00002196OtherRR MEDICARE PIN
TNP00002196OtherRR MEDICARE PIN
TN3307580Medicaid
TN3706635Medicare ID - Type UnspecifiedLEGACY GROUP