Individual
RUSSELL WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
110 HOSPITAL DR, JEFFERSON CITY, TN 37760-5281
(865) 471-2300
(865) 471-2463
Mailing address
1431 CENTERPOINT BLVD, SUITE 100, KNOXVILLE, TN 37932-1984
(865) 985-7012
(865) 291-3224
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2489
TN
363A00000X
Physician Assistant
—
—
Other
Enumeration date
02/03/2014
Last updated
11/01/2021
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