Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 3110 | TN |
NPI | 1881242212 |
---|---|
Provider Name | Dr. Paul Caleb Edmiston |
First Address | Knoxville, TN 37909-2615 |
Second Address | Knoxville, TN 37922-3188 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2019 |
Last Update Date | 28/08/2019 |