| Scenic City Neurotherapy Ketamine And Tms | |
|
7405 Shallowford Rd Ste 240 Chattanooga TN 37421-2662 | |
| (423) 228-0579 | |
| Not Available |
| Full Name | Scenic City Neurotherapy Ketamine And Tms |
|---|---|
| Speciality | Nurse Anesthetist, Certified Registered |
| Location | 7405 Shallowford Rd Ste 240, Chattanooga, Tennessee |
| Authorized Official Name and Position | Charles Brian Miller (CMO) |
| Authorized Official Contact | 4232902411 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Scenic City Neurotherapy Ketamine And Tms 7405 Shallowford Rd Ste 240 Chattanooga TN 37421-2662 Ph: (423) 228-0579 | Scenic City Neurotherapy Ketamine And Tms 7405 Shallowford Rd Ste 240 Chattanooga TN 37421-2662 Ph: (423) 228-0579 |
| NPI Number | 1366077539 |
|---|---|
| Provider Enumeration Date | 03/09/2020 |
| Last Update Date | 11/29/2023 |
| Certification Date | 07/10/2023 |
| Medicare PECOS PAC ID | 7416386941 |
|---|---|
| Medicare Enrollment ID | O20200406000155 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366077539 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
| 367500000X | Nurse Anesthetist, Certified Registered | (* (Not Available)) | Primary |
| Provider Name | Ahmed A Ibrahim |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407188626 PECOS PAC ID: 4082848148 Enrollment ID: I20131004000233 |
| Provider Name | Charles Brian Miller |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1376087502 PECOS PAC ID: 3072896067 Enrollment ID: I20170217001460 |
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