Individual
DR. ERIC R NICELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7557 DANNAHER LN, SUITE 230, POWELL, TN 37849-3558
(865) 637-9431
(865) 637-8887
Mailing address
9724 KINGSTON PIKE, SUITE 800, KNOXVILLE, TN 37922-3347
(865) 690-0602
(865) 690-0515
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD0000019805
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1669416442
GROUP NPI
TN
05
—
3084254
—
TN
01
—
3106070
BLUE CROSS
TN
01
—
3106086
BLUE CROSS
TN
01
—
CI2260
RAILROAD MEDICARE
TN
Enumeration date
07/29/2005
Last updated
12/07/2007
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