Basic Information
| Provider Information | |||||||||
| NPI: | 1144513029 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORTHOTENNESSEE, PC | ||||||||
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| OtherOrganizationName: | ORTHOPAEDIC SURGEONS OF OAK RIDGE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1855 TANNER WAY STE 110 | ||||||||
| Address2: | |||||||||
| City: | HARRIMAN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377488331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654829025 | ||||||||
| FaxNumber: | 8654838151 | ||||||||
| Practice Location | |||||||||
| Address1: | 1855 TANNER WAY | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | HARRIMAN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377480000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8653762775 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2011 | ||||||||
| LastUpdateDate: | 02/11/2021 | ||||||||
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| AuthorizedOfficialLastName: | DEESON | ||||||||
| AuthorizedOfficialFirstName: | JON-DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8657694545 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.