Provider Demographics
NPI:1144361619
Name:GENERATIONS OBGYN,P.C.
Entity type:Organization
Organization Name:GENERATIONS OBGYN,P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BACON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-769-4412
Mailing Address - Street 1:9430 PARKWEST BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:KNOXVILLE
Mailing Address - State:NE
Mailing Address - Zip Code:37923
Mailing Address - Country:US
Mailing Address - Phone:865-769-4444
Mailing Address - Fax:
Practice Address - Street 1:9430 PARK WEST BLVD STE 320
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4203
Practice Address - Country:US
Practice Address - Phone:865-769-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3702820Medicare ID - Type Unspecified