Provider Demographics
NPI:1588409585
Name:LOGAN DAMERON NP-C PC
Entity type:Organization
Organization Name:LOGAN DAMERON NP-C PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP-C; OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:423-360-2383
Mailing Address - Street 1:5835 WALL FLOWER LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37924-1599
Mailing Address - Country:US
Mailing Address - Phone:423-360-2383
Mailing Address - Fax:
Practice Address - Street 1:10430 LOVELL CENTER DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3227
Practice Address - Country:US
Practice Address - Phone:865-693-6620
Practice Address - Fax:865-693-2909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care