Basic Information
| Provider Information | |||||||||
| NPI: | 1932318284 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TENNESSEE UROLOGY ASSOCIATES, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9724 KINGSTON PIKE | ||||||||
| Address2: | SUITE 800 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379223347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656900602 | ||||||||
| FaxNumber: | 8656900515 | ||||||||
| Practice Location | |||||||||
| Address1: | 7557 DANNAHER WAY | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | POWELL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378493558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659385222 | ||||||||
| FaxNumber: | 8659385264 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 06/20/2012 | ||||||||
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| AuthorizedOfficialLastName: | WALLACE | ||||||||
| AuthorizedOfficialFirstName: | RUTH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8656900602 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.