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Organization
KNOXVILLE MEDICAL GROUP, LLC
Active
Organization
KNOXVILLE MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMBER D ROBERTS (BILLING/CREDENTIALING)
(423) 736-3649
Entity
Organization
Contact information
Practice address
7523 MAYNARDVILLE PIKE, KNOXVILLE, TN 37938-3722
(865) 630-4302
Mailing address
7523 MAYNARDVILLE PIKE, KNOXVILLE, TN 37938
(865) 630-4302
(865) 630-4303
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
21594
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053764761
NPI
TN
01
—
21594
STATE LICENSE
TN
Enumeration date
10/24/2017
Last updated
04/20/2022
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