Provider Demographics
NPI:1528007408
Name:CARRICK, RHONDA R (PAC)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:R
Last Name:CARRICK
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 GUNBARREL RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3192
Mailing Address - Country:US
Mailing Address - Phone:423-499-4100
Mailing Address - Fax:
Practice Address - Street 1:1720 GUNBARREL RD
Practice Address - Street 2:SUITE 400
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3192
Practice Address - Country:US
Practice Address - Phone:423-499-4100
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA01242363AM0700X
GA4489363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q52620Medicare UPIN