Basic Information
| Provider Information | |||||||||
| NPI: | 1326695537 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | APP OF EAST TENNESSEE ED PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5121 MARYLAND WAY STE 300 | ||||||||
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| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370277516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159286268 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7565 DANNAHER DR | ||||||||
| Address2: | |||||||||
| City: | POWELL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378494029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159286268 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2019 | ||||||||
| LastUpdateDate: | 03/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | SOMERBY | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 6292063254 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.