Provider Demographics
NPI:1831598689
Name:KNOXVILLE GASTROENTEROLOGY CONSULTANTS PLLC
Entity type:Organization
Organization Name:KNOXVILLE GASTROENTEROLOGY CONSULTANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAYS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:865-531-4724
Mailing Address - Street 1:10800 PARKSIDE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1922
Mailing Address - Country:US
Mailing Address - Phone:865-531-4724
Mailing Address - Fax:865-691-4526
Practice Address - Street 1:10800 PARKSIDE DR STE 201
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1922
Practice Address - Country:US
Practice Address - Phone:865-531-4724
Practice Address - Fax:865-691-4526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9663207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3194492OtherMEDICARE PTAN