Provider Demographics
NPI:1477844553
Name:SUTHERLAND, PHILIP ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:ANTHONY
Last Name:SUTHERLAND
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 1:3551 TIFTONIA DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37419-1326
Mailing Address - Country:US
Mailing Address - Phone:423-778-2957
Mailing Address - Fax:
Practice Address - Street 1:1300 E 23RD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-5701
Practice Address - Country:US
Practice Address - Phone:423-760-4000
Practice Address - Fax:423-760-4501
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49902207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine