Provider Demographics
NPI:1255178786
Name:UNIVERSITY OF TENNESSEE
Entity type:Organization
Organization Name:UNIVERSITY OF TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RAAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:KURAPATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-448-8030
Mailing Address - Street 1:117 W SEVIER AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3770
Mailing Address - Country:US
Mailing Address - Phone:423-933-3773
Mailing Address - Fax:423-933-3726
Practice Address - Street 1:117 W SEVIER AVE STE 220
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3770
Practice Address - Country:US
Practice Address - Phone:423-933-3773
Practice Address - Fax:423-933-3726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty