Provider Demographics
NPI:1962448860
Name:HALLWACHS, TERRY L (PA)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:HALLWACHS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 N PETERS RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-2356
Mailing Address - Country:US
Mailing Address - Phone:865-694-7725
Mailing Address - Fax:865-483-4194
Practice Address - Street 1:988 OAK RIDGE TPKE
Practice Address - Street 2:SUITE 100
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6930
Practice Address - Country:US
Practice Address - Phone:865-483-8478
Practice Address - Fax:865-483-4194
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3957363AM0700X
TN1571363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
3376144Medicare PIN