1285476648 NPI number — MR. TOM MORRIS GARDENHIRE III M.S.

Table of content: MR. TOM MORRIS GARDENHIRE III M.S. (NPI 1285476648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285476648 NPI number — MR. TOM MORRIS GARDENHIRE III M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARDENHIRE
Provider First Name:
TOM
Provider Middle Name:
MORRIS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
III
Provider Credential Text:
M.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285476648
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
116 AGNES RD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37919-6306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-641-8629
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3505 ADKISSON DR NW STE 152&153
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37312-6803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-641-8629
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  2493 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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