Provider Demographics
NPI:1750504361
Name:INFECTIOUS DISEASE PHYSICIANS OF CHATTANOOGA, PLLC
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE PHYSICIANS OF CHATTANOOGA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-495-2650
Mailing Address - Street 1:725 GLENWOOD DR
Mailing Address - Street 2:SUITE E-486
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1163
Mailing Address - Country:US
Mailing Address - Phone:423-495-2650
Mailing Address - Fax:423-495-2655
Practice Address - Street 1:725 GLENWOOD DR
Practice Address - Street 2:SUITE E-486
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1163
Practice Address - Country:US
Practice Address - Phone:423-495-2650
Practice Address - Fax:423-495-2655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G03282Medicare UPIN
TN3370050Medicare PIN