Provider Demographics
NPI:1821350604
Name:WILKES, JUSTIN GRANT (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:GRANT
Last Name:WILKES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1949 GUNBARREL RD STE 206
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7133
Mailing Address - Country:US
Mailing Address - Phone:423-495-4345
Mailing Address - Fax:423-495-4934
Practice Address - Street 1:721 GLENWOOD DR STE 550&W553
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1106
Practice Address - Country:US
Practice Address - Phone:423-698-2869
Practice Address - Fax:423-624-7813
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAMD-42958208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice