| State Of Tennessee | |
|
1522 Cherokee Trl Knoxville TN 37920-2205 | |
| (865) 549-5241 | |
| (865) 594-5833 |
| Full Name | State Of Tennessee |
|---|---|
| Speciality | Clinic/center - Public Health, State Or Local |
| Location | 1522 Cherokee Trl, Knoxville, Tennessee |
| Authorized Official Name and Position | Marianne Faneuil Sharp (REGIONAL ACCOUNTANT) |
| Authorized Official Contact | 8655495266 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| State Of Tennessee Po Box 59019 Knoxville TN 37950-9019 Ph: (865) 549-5241 | State Of Tennessee 1522 Cherokee Trl Knoxville TN 37920-2205 Ph: (865) 549-5241 |
| NPI Number | 1023232949 |
|---|---|
| Provider Enumeration Date | 04/12/2007 |
| Last Update Date | 08/23/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023232949 | NPI | - | NPPES |
| 444-7933 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP0905X | Clinic/center - Public Health, State Or Local | (* (Not Available)) | Primary |
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