Provider Demographics
NPI:1184654956
Name:WORTHINGTON, JULIAN MACK (MD)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:MACK
Last Name:WORTHINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2241
Mailing Address - Country:US
Mailing Address - Phone:423-778-8837
Mailing Address - Fax:423-778-9301
Practice Address - Street 1:1100 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2201
Practice Address - Country:US
Practice Address - Phone:423-778-8837
Practice Address - Fax:423-778-9301
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13029207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3183105Medicare ID - Type Unspecified
TNB04060Medicare UPIN