Provider Demographics
NPI:1992774665
Name:MACLELLAN, ANDREW JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JAMES
Last Name:MACLELLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 FORT SANDERS WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3355
Mailing Address - Country:US
Mailing Address - Phone:865-769-4545
Mailing Address - Fax:865-769-4501
Practice Address - Street 1:460 MEDICAL PARK DR
Practice Address - Street 2:SUITE 104
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5782
Practice Address - Country:US
Practice Address - Phone:865-986-7737
Practice Address - Fax:865-986-7807
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD38368207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3891250Medicaid
TN4083589OtherBLUE CROSS BLUE SHIELD
TNTN01J7OtherJOHN DEERE HEALTHCARE
TNP00199559OtherRAILROAD MEDICARE
I04068Medicare UPIN
TN103I200689Medicare PIN
TN3711721Medicare PIN
TN3891250Medicaid
TN3734041Medicare PIN