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6106 Shallowford Rd # 108 Chattanooga TN 37421-1615 | |
(423) 553-6636 | |
(423) 553-6667 |
Full Name | |
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Speciality | Internal Medicine |
Location | 6106 Shallowford Rd, Chattanooga, Tennessee |
Authorized Official Name and Position | Philip A Bannor (PRESIDENT) |
Authorized Official Contact | 4235536636 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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6106 Shallowford Rd # 108 Chattanooga TN 37421-1615 Ph: (423) 553-6636 | 6106 Shallowford Rd # 108 Chattanooga TN 37421-1615 Ph: (423) 553-6636 |
NPI Number | 1568596823 |
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Provider Enumeration Date | 03/16/2007 |
Last Update Date | 02/16/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1568596823 | NPI | - | NPPES |
3728871 | Medicaid | TN |
Taxonomy | Type | License (State) | Status |
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207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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