Provider Demographics
NPI:1568494284
Name:STANDRIDGE, JOHN BRENDLE II (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BRENDLE
Last Name:STANDRIDGE
Suffix:II
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 1:6838 BUCK TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:TN
Mailing Address - Zip Code:37341-4912
Mailing Address - Country:US
Mailing Address - Phone:423-531-4265
Mailing Address - Fax:423-531-4267
Practice Address - Street 1:207 SPEARS AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405
Practice Address - Country:US
Practice Address - Phone:423-531-4265
Practice Address - Fax:423-531-4267
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2018-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9010207Q00000X, 207QA0401X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3157266Medicaid
B59262Medicare UPIN
TN3157266Medicaid
TNB59262Medicare UPIN