Provider Demographics
NPI:1689970030
Name:FARRELLY, JAMES IAN (PA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:IAN
Last Name:FARRELLY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3544 VALLEY TRL
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-3913
Mailing Address - Country:US
Mailing Address - Phone:423-838-7600
Mailing Address - Fax:
Practice Address - Street 1:1067 RIVERFRONT PKWY
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-2194
Practice Address - Country:US
Practice Address - Phone:423-602-9530
Practice Address - Fax:423-493-2370
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1927363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical