Provider Demographics
NPI:1366405185
Name:ESTEY, DOUGLAS (PAC)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:ESTEY
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 PARKWAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-3469
Mailing Address - Country:US
Mailing Address - Phone:865-774-4440
Mailing Address - Fax:865-774-4868
Practice Address - Street 1:441 PARKWAY
Practice Address - Street 2:SUITE 2
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3469
Practice Address - Country:US
Practice Address - Phone:865-774-4440
Practice Address - Fax:865-774-4868
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1404363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3665216Medicaid
TN3734041Medicare PIN