Provider Demographics
NPI:1184359747
Name:MARYVILLE INTERVENTIONAL PSYCHIATRY PLLC
Entity type:Organization
Organization Name:MARYVILLE INTERVENTIONAL PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPOLLO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:865-951-3927
Mailing Address - Street 1:2211 E BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-3078
Mailing Address - Country:US
Mailing Address - Phone:865-269-7582
Mailing Address - Fax:865-233-9046
Practice Address - Street 1:2211 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-3078
Practice Address - Country:US
Practice Address - Phone:865-269-7582
Practice Address - Fax:865-233-9046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-19
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty