Provider Demographics
NPI:1326069089
Name:MCPHERSON, GARTH D (MD)
Entity Type:Individual
Prefix:
First Name:GARTH
Middle Name:D
Last Name:MCPHERSON
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 1:1604 GUNBARREL RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3125
Mailing Address - Country:US
Mailing Address - Phone:423-648-2395
Mailing Address - Fax:423-648-7542
Practice Address - Street 1:1604 GUNBARREL RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3125
Practice Address - Country:US
Practice Address - Phone:423-893-7226
Practice Address - Fax:423-893-7398
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0493092085R0202X
TNMD346182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000913415Medicaid
GA005992OtherBCBS OF GA
TN3857816Medicaid
TN4073012OtherBCBS OF TN
GA772995OtherBCBS OF GA
TN3163874OtherBCBS OF TN
TN3857816Medicare PIN
GA30BDLFXMedicare PIN
GA772995OtherBCBS OF GA
E85396Medicare UPIN
GAP00045951Medicare PIN
GA000913415Medicaid
TN3857817Medicare PIN
GAP00103239Medicare PIN