Basic Information
| Provider Information | |||||||||
| NPI: | 1568444032 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RHEUMATOLOGY ASSOCIATES OF ETN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 324 N PARK 40 BLVD | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379233624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656914100 | ||||||||
| FaxNumber: | 8656916178 | ||||||||
| Practice Location | |||||||||
| Address1: | 324 N PARK 40 BLVD | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379233624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656914100 | ||||||||
| FaxNumber: | 8656916178 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BURNS | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8656914100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 013564 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 091320 | 01 | TN | BLUE CROSS | OTHER |