Provider Demographics
NPI:1174738512
Name:ENGUM, ERIC S (PHD, JD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:S
Last Name:ENGUM
Suffix:
Gender:M
Credentials:PHD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CROSS PARK PLAZA, SUITE D266
Mailing Address - Street 2:9111 CROSS PARK DRIVE
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4506
Mailing Address - Country:US
Mailing Address - Phone:865-531-0560
Mailing Address - Fax:865-531-2846
Practice Address - Street 1:CROSS PARK PLAZA, SUITE D266
Practice Address - Street 2:9111 CROSS PARK DRIVE
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4506
Practice Address - Country:US
Practice Address - Phone:865-531-0560
Practice Address - Fax:865-531-2846
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000000908103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist