Provider Demographics
NPI:1508174210
Name:ALEXANDER, JOHN D (CO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 BRAINERD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-3603
Mailing Address - Country:US
Mailing Address - Phone:423-697-0057
Mailing Address - Fax:423-648-9366
Practice Address - Street 1:3700 BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-3603
Practice Address - Country:US
Practice Address - Phone:423-697-0057
Practice Address - Fax:423-648-9366
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO004822174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000973794CMedicaid
TN1455062Medicaid
GA000973794EMedicaid
GA000973794DMedicaid
TN1507472Medicaid
TN1254770003Medicare NSC
TN1455062Medicaid