Basic Information
| Provider Information | |||||||||
| NPI: | 1073589925 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | BRITTIAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 888213 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656706199 | ||||||||
| FaxNumber: | 8656706188 | ||||||||
| Practice Location | |||||||||
| Address1: | 6516 KINGSTON PIKE | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379194825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654509361 | ||||||||
| FaxNumber: | 8654509362 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 02/28/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 39757 | TN | Y | Allopathic & Osteopathic Physicians | Dermatology | 207NS0135X | 39757 | TN | N | Allopathic & Osteopathic Physicians | Dermatology | Procedural Dermatology | 207ND0900X | 39757 | TN | N | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology |
ID Information
| ID | Type | State | Issuer | Description | 33313421 | 05 | TN | MEDICAID | 64109978 | 01 | KY | KY MEDICAID | OTHER |