Provider Demographics
NPI:1780683136
Name:ANDERSON, DAVID Q (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:Q
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 CIRCLE 75 PKWY SE STE 900
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3084
Mailing Address - Country:US
Mailing Address - Phone:678-426-2171
Mailing Address - Fax:404-446-1957
Practice Address - Street 1:3742 TENNESSEE AVE STE 108
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37409
Practice Address - Country:US
Practice Address - Phone:423-702-6453
Practice Address - Fax:423-485-3893
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN771213E00000X
AL209213E00000X
GAPOD001283213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ019441Medicaid
ALU67579Medicare UPIN
AL6249330001Medicare NSC
AL6249330001OtherMEDICARE DME
AL1043456254OtherGROUP NPI
AL1043456254OtherGROUP NPI