Provider Demographics
NPI:1104215656
Name:FORENSIC MEDICINE ASSOCIATES INC
Entity type:Organization
Organization Name:FORENSIC MEDICINE ASSOCIATES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ALVA
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-862-0763
Mailing Address - Street 1:110 PERIMETER PARK RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-2247
Mailing Address - Country:US
Mailing Address - Phone:865-862-0763
Mailing Address - Fax:865-862-0764
Practice Address - Street 1:110 PERIMETER PARK RD
Practice Address - Street 2:SUITE C
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-2247
Practice Address - Country:US
Practice Address - Phone:865-862-0763
Practice Address - Fax:865-862-0764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19179261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TND93124Medicare UPIN