Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 36410 | TN |
N | 111NI0900X | Internist | 36410 | TN |
N | 207RC0000X | Internist - Cardiovascular Disease | 36410 | TN |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 36410 | TN |
NPI | 1205830171 |
---|---|
Provider Name | William Jeremy Mahlow |
First Address | Knoxville, TN 37920-2244 |
Second Address | Knoxville, TN 37920-2244 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 14/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H84815 | (02) | TN |