Provider Demographics
NPI:1760537732
Name:FORT SANDERS CLINIC PARTNERSHIP
Entity Type:Organization
Organization Name:FORT SANDERS CLINIC PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:STRANGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-524-2551
Mailing Address - Street 1:2214 WHITE AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-2218
Mailing Address - Country:US
Mailing Address - Phone:865-524-2551
Mailing Address - Fax:865-522-3550
Practice Address - Street 1:2214 WHITE AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2218
Practice Address - Country:US
Practice Address - Phone:865-524-2551
Practice Address - Fax:865-522-3550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000001386103TC1900X
TNP0000001294103TC1900X
TNLSW00000004611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty