Basic Information
| Provider Information | |||||||||
| NPI: | 1720172489 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TENNESSEE UROLOGY ASSOCIATES, PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TENNESSEE UROLOGY ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 CROSSROADS DR STE 306 | ||||||||
| Address2: | |||||||||
| City: | OWINGS MILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211175437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669533111 | ||||||||
| FaxNumber: | 4434718540 | ||||||||
| Practice Location | |||||||||
| Address1: | 9245 PARK WEST BLVD | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379234425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8652762764 | ||||||||
| FaxNumber: | 8656947621 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 12/17/2020 | ||||||||
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| AuthorizedOfficialLastName: | LAUTERBACH | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 4437382889 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332900000X | Y | Suppliers | Non-Pharmacy Dispensing Site |
No ID Information.