Provider Demographics
NPI:1760480321
Name:MCCARLEY, JOHN D (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:MCCARLEY
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 1:2300 E 3RD ST STE B
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2700
Mailing Address - Country:US
Mailing Address - Phone:423-702-7900
Mailing Address - Fax:423-702-7905
Practice Address - Street 1:251 N LYERLY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2739
Practice Address - Country:US
Practice Address - Phone:423-826-8000
Practice Address - Fax:423-702-7915
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN28588207RN0300X
GA047234207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3826827Medicaid
G72282Medicare UPIN
3826829Medicare ID - Type Unspecified
GA39BDCCQMedicare PIN