Provider Demographics
NPI:1144504291
Name:SMOKEY MOUNTAIN ADULT CARE
Entity type:Organization
Organization Name:SMOKEY MOUNTAIN ADULT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:CREWS-FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-633-9469
Mailing Address - Street 1:216 PHOENIX CT
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-3914
Mailing Address - Country:US
Mailing Address - Phone:865-573-2678
Mailing Address - Fax:
Practice Address - Street 1:216 PHOENIX CT
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-3914
Practice Address - Country:US
Practice Address - Phone:865-573-2678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED PAIN THERAPEUTICS OF KNOXVILLE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty