| NPI | 1215392030 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YOUHANNA S. AL-TAWIL Owner 865-546-3998 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080P0206X Pediatrics Pediatric Gastroenterology |
| Additional Taxonomies | 2080P0206X Pediatrics Pediatric Gastroenterology |
| 363AM0700X Physician Assistant Medical | |
| 363AS0400X Physician Assistant Surgical | |
| 363LP0200X Nurse Practitioner Pediatrics | |
| Enumeration Date | 2015-12-21 |
| Last Update Date | 2022-10-05 |