Provider Demographics
NPI:1760524029
Name:COMPLETE FAMILY CARE OF KNOXVILLE PLLC
Entity Type:Organization
Organization Name:COMPLETE FAMILY CARE OF KNOXVILLE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SUGANTHARAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-357-8861
Mailing Address - Street 1:1612 DOWNTOWN WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5408
Mailing Address - Country:US
Mailing Address - Phone:865-357-8861
Mailing Address - Fax:865-357-8866
Practice Address - Street 1:1612 DOWNTOWN WEST BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5408
Practice Address - Country:US
Practice Address - Phone:865-357-8861
Practice Address - Fax:865-357-8866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000009519207R00000X
TN111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370189Medicaid
3370189Medicare PIN