Provider Demographics
NPI:1437170180
Name:HUNTZINGER, GRANT W (MD)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:W
Last Name:HUNTZINGER
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
GA0224202085R0202X
TNMD115682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4073000OtherBCBS OF TN
TN44770OtherBCBS OF TN
GA151364OtherBCBS OF GA
TN3805918Medicaid
GA000248476Medicaid
GA511425OtherBCBS OF GA
TN3805919Medicare PIN
GA30CDBWXMedicare PIN
GA511425OtherBCBS OF GA
E91365Medicare UPIN
GAP00103255Medicare PIN
TN3805918Medicaid
TN3805918Medicare PIN
TN300022464Medicare PIN