Provider Demographics
NPI:1851338628
Name:WILES, DAVID ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:WILES
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 1:2205 MCCALLIE AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3334
Mailing Address - Country:US
Mailing Address - Phone:423-756-6623
Mailing Address - Fax:423-648-8084
Practice Address - Street 1:2205 MCCALLIE AVE STE 310
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3334
Practice Address - Country:US
Practice Address - Phone:423-756-6623
Practice Address - Fax:423-648-8084
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000028672207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3808338Medicaid
G44077Medicare UPIN
3808338Medicare PIN