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Ethan Dudley
NPI 1750964284 · on the registry since 2021
Practice
- Address
- 1632 W Broadway Ave
Maryville, TN 37801 - Phone
- (865) 984-1996
- Fax
- (865) 984-1997
- Organisation at this address
- Agilitas Usa, Inc
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 9
Registry record
- Primary taxonomy
- 225100000X
225100000X
- Also registered as
- 225100000X
- Licence states on file
- TN
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2021-05-26
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Tennessee