Knoxville Dermatology Group PC
Organization Active NPI Dermatology Physician · Knoxville, TN
NPI 1760419014 · NPPES record last updated Jun 13, 2023
Key facts
- NPI
- 1760419014
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- Legal business name
- KNOXVILLE DERMATOLOGY GROUP PC
- Practice address
- 123 Fox Rd
Knoxville, TN 37922-3369 - Phone
- (865) 690-9467
- Fax
- (865) 381-6287
- NPI assigned
- Jun 26, 2006
- Organization subpart
- No
Authorized official
- Name
- Angela Peterman, MD
- Title
- Owner
- Phone
- (865) 690-9467
Practitioners 40
-
Sheri L Chapman, FNP
-
Elizabeth Noble Ergen, M.D.
-
Misty Dawn Hammond, FNP
-
Matthew C Hanggi, MD
-
Constance L Hayes, DNP, APRNC, FNP-C
-
Melissa F. Headrick, ANP-BC
-
Drew Wilson Miller, M.D.
-
Edward John Primka III, M.D.
-
Angela H. Smith, FNP
-
Sandra Vaughn, NP
-
Kimberly Dawn Vincent, M.D.
-
Sharon A Brown, MSN, FNP, DCNP
-
Kevin Blazer, PA-C
-
Whitney Elan Colella, PA-C
-
Lee B Dittrich, MD
-
Brooke Renae Huff, PA-C
-
Paul C. Maben, P.A.
-
Amy Browning Maurer, PA-C
-
Sharon L McNutt, P.A.
-
Marcus Rene Ortiz Jr., PA-C
-
Ashley D Pierson, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D0312905 | Knoxville Dermatology Group | Compliance | Dec 6, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040528000815 | TN | Part B Supplier - Clinic/Group Practice | 8123009636 |
Receives reassigned benefits from 34 practitioners Practice locations: Sevierville, TN; Powell, TN; Knoxville, TN; Alcoa, TN |
National Provider Directory
Locations
11416 Grigsby Chapel Rd
Ste 102
Knoxville, TN 37934
Phone (865) 392-1717
109 Suburban Rd
#C101
Knoxville, TN 37923
Phone (865) 690-7130
123 Fox Rd
Ste 100
Knoxville, TN 37922
123 Fox Rd
Knoxville, TN 37922
Phone (865) 342-5811
1450 Dowell Springs Blvd
#200
Knoxville, TN 37909
423 Medical Park Dr
Ste 600
Lenoir City, TN 37772
Phone (865) 271-6650
7557 Dannaher Dr
Ste G20
Powell, TN 37849
Phone (865) 362-8507
740 Middle Creek Rd
Ste 114
Sevierville, TN 37862
Phone (865) 690-9467
1104 Foxwood Dr
Ste B
Sevierville, TN 37862
Phone (865) 690-9467
824 Middle Creek Rd
Sevierville, TN 37862
Phone (865) 429-8773
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | Yes |
Addresses
Primary practice location
123 Fox Rd
Knoxville, TN 37922-3369
Mailing address
123 Fox Rd
Knoxville, TN 37922-3369
Phone (865) 690-9467
Other providers in Knoxville, TN
- Knoxville Dental, PC
- Knoxville Dentistry Group PLLC
- Knoxville Dermatology Group PC
- Knoxville Dermatology Group PC
- Knoxville Dermatology Group PC
- Knoxville Dietitian Services
- Knoxville Emergency Physicians Group PC
- Knoxville Endocrinology Clinic, LLC
- Knoxville Eye Anesthesia LLC
- Knoxville Eye Care Center
All providers in Knoxville, TN · Dermatology 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 Jun 13, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.