Basic Information
| Provider Information | |||||||||
| NPI: | 1558661561 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VOLLMER | ||||||||
| FirstName: | CHRISTY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1937 RIDGEWOOD DR | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377605303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898908185 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1819 W CLINCH AVE | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379162435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655465111 | ||||||||
| FaxNumber: | 8655414018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2010 | ||||||||
| LastUpdateDate: | 06/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 2108 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 2108 | 01 | TN | LICENSE | OTHER |