Provider Demographics
NPI:1841225406
Name:PARHAM, BERNARD L SR (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:L
Last Name:PARHAM
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3475 BRAINERD RD BLDG B
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-3542
Mailing Address - Country:US
Mailing Address - Phone:423-800-8337
Mailing Address - Fax:423-760-8257
Practice Address - Street 1:3475 BRAINERD RD BLDG B
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411
Practice Address - Country:US
Practice Address - Phone:423-800-8337
Practice Address - Fax:423-760-8257
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN021556207R00000X
TNMD0000021556174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN62-1577996OtherEIN
TN62-1577996OtherEIN