Provider Demographics
NPI:1649511965
Name:EAST TENNESSEE NEUROPATHY, PC
Entity type:Organization
Organization Name:EAST TENNESSEE NEUROPATHY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:LENSGRAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-794-3142
Mailing Address - Street 1:PO BOX 50998
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-0998
Mailing Address - Country:US
Mailing Address - Phone:423-794-3142
Mailing Address - Fax:423-794-3184
Practice Address - Street 1:818 SUNSET DR
Practice Address - Street 2:SUITE 103
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-8310
Practice Address - Country:US
Practice Address - Phone:423-794-3142
Practice Address - Fax:423-794-3184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36478207Q00000X
TN18742207R00000X
TN1826363A00000X
TN15083363L00000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty