Organization
STATE OF TENNESSEE
Active
Organization
STATE OF TENNESSEE
Active
Other names
East Tenn Regional Office - Other Clinics
Organization subpart
No
Provider details
NPI number
Authorized official
MARIANNE FANEUIL SHARP (REGIONAL ACCOUNTANT)
(865) 549-5266
Entity
Organization
Contact information
Practice address
1522 CHEROKEE TRL, KNOXVILLE, TN 37920-2205
(865) 549-5241
(865) 594-5833
Mailing address
PO BOX 59019, KNOXVILLE, TN 37950-9019
(865) 549-5241
(865) 594-5833
Taxonomy
Speciality
Code
Description
License number
State
261QP0905X
State or Local Public Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
444-7933
—
TN
Enumeration date
04/12/2007
Last updated
08/23/2010
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