Provider Demographics
NPI:1013166024
Name:SEASONS OF FARRAGUT PLLC
Entity Type:Organization
Organization Name:SEASONS OF FARRAGUT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:GOODYEAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-675-9355
Mailing Address - Street 1:10607 DEERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-1942
Mailing Address - Country:US
Mailing Address - Phone:865-675-9355
Mailing Address - Fax:
Practice Address - Street 1:10607 DEERBROOK DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-1942
Practice Address - Country:US
Practice Address - Phone:865-675-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty