Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 9474 | TN |
NPI | 1164664140 |
---|---|
Provider Name | Dr. David O Pickett |
First Address | Knoxville, TN 37923-4925 |
Second Address | Knoxville, TN 37923-4925 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2009 |
Last Update Date | 09/04/2014 |