1912121302 NPI number — MRS. MEGHAN ELIZABETH PETERS M.D., PHARMD

Table of content: MRS. MEGHAN ELIZABETH PETERS M.D., PHARMD (NPI 1912121302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912121302 NPI number — MRS. MEGHAN ELIZABETH PETERS M.D., PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETERS
Provider First Name:
MEGHAN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D., PHARMD
Provider Gender Code:
F

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:
1912121302
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1275 DICK LONAS RD UNIT 101
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:
37909-1383
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-500-2144
Provider Business Mailing Address Fax Number:
865-584-1363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11021 CHAPMAN HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEYMOUR
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-579-3720
Provider Business Practice Location Address Fax Number:
865-577-7309
Provider Enumeration Date:
04/13/2007

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: 183500000X , with the licence number:  17712 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 51682 , 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)

  • Identifier: Q007766 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com