Provider Demographics
NPI:1659375491
Name:CHERRY, COLLIN G (MD)
Entity Type:Individual
Prefix:DR
First Name:COLLIN
Middle Name:G
Last Name:CHERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:725 GLENWOOD DR
Mailing Address - Street 2:SUITE 480
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1163
Mailing Address - Country:US
Mailing Address - Phone:423-756-5779
Mailing Address - Fax:423-242-4552
Practice Address - Street 1:725 GLENWOOD DR
Practice Address - Street 2:SUITE 480
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1163
Practice Address - Country:US
Practice Address - Phone:423-756-5779
Practice Address - Fax:423-242-4552
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17136207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3033351Medicaid
93335OtherBCBSTN
TN3033356Medicare ID - Type Unspecified
93335OtherBCBSTN