Provider Demographics
NPI:1699829226
Name:SOWTER, BRENDA K (DO)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:K
Last Name:SOWTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81118
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37414-8318
Mailing Address - Country:US
Mailing Address - Phone:423-899-2204
Mailing Address - Fax:423-698-4045
Practice Address - Street 1:1511 MAIN ST
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:TN
Practice Address - Zip Code:37347-5551
Practice Address - Country:US
Practice Address - Phone:423-837-6000
Practice Address - Fax:423-837-6009
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0000001174207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3048544Medicaid
TN1699829226OtherNPI
TN1699829226OtherNPI
TN3048544Medicaid
TN1699829226OtherNPI
TN33-0510172OtherTAX ID NUMBER