Individual
MR. JORDAN RILEY CORMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
1901 CLINCH AVE, KNOXVILLE, TN 37916-2307
(865) 541-1111
Mailing address
9056 HIGHBRIDGE DR, KNOXVILLE, TN 37922-1439
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q056756
—
TN
Enumeration date
01/22/2020
Last updated
06/02/2022
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