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Organization

PRODIGAL PRIMARY CARE PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DAVID E BRICKHOUSE (OWNER)
(865) 288-3754
Entity
Organization

Contact information

Practice address
2911 ESSARY ROAD, KNOXVILLE, TN 37918-2468
(865) 288-2754
(865) 243-2250
Mailing address
2911 ESSARY ROAD, KNOXVILLE, TN 37918-2468
(865) 288-3754
(865) 243-2250

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1506
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1521979
TN
Enumeration date
07/13/2010
Last updated
08/21/2013
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