East Tennessee Children'S Primary Care Center, Inc.
Organization Active NPI Pediatrics Physician · Harriman, TN
NPI 1669104196 · NPPES record last updated Sep 5, 2026
Key facts
- NPI
- 1669104196
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- EAST TENNESSEE CHILDREN'S PRIMARY CARE CENTER, INC.
- Practice address
- 1705 Roane State Hwy
Harriman, TN 37748-8306 - Phone
- (865) 316-5001
- Fax
- (865) 376-3713
- NPI assigned
- Jun 24, 2022
- Organization subpart
- Yes
- Parent organization (as reported)
- EAST TENNESSEE CHILDREN'S PRIMARY CARE CENTER, INC.
Authorized official
- Name
- Andrew Rosendahl
- Title
- Chief Financial Officer
- Phone
- (865) 541-8154
Corporate family (same tax ID) 13
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D2267424 | East TN Children'S Primary Care Inc, | Certificate of waiver | Mar 30, 2028 |
National Provider Directory
- Tax ID family
- East Tennessee Children'S Hospital Primary Care Center Inc
- Part of
- East Tennessee Children'S Hospital Primary Care Center Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | Yes | ||
| Family Nurse Practitioner |
363LF0000X | |||
| Pediatric Nurse Practitioner |
363LP0200X |
Addresses
Primary practice location
1705 Roane State Hwy
Harriman, TN 37748-8306
Mailing address
PO Box 50068
Knoxville, TN 37950-0068
Phone (865) 541-8895
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q074655 | Medicaid | TN |
Other names
- Dolly Parton Children's Hospital Roane County Pediatrics
- Roane County Pediatrics
Other providers in Harriman, TN
- Kesha Dryman
- Babulal Dudani
- Michelle Duke
- Robert A Dukes
- Lauren R Duncan
- Patrecia Elise Eaton
- James Hollis Eble
- Jason Hollis Eble
- Samer A El-Chemeitelli
- Conway Ella
All providers in Harriman, TN · Pediatrics Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 5, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.