Provider Demographics
NPI:1851595300
Name:INTERNAL MEDICINE & WOUND CONSULTANTS, INC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE & WOUND CONSULTANTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:FALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-855-0700
Mailing Address - Street 1:5751 UPTAIN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-4010
Mailing Address - Country:US
Mailing Address - Phone:423-894-5466
Mailing Address - Fax:423-424-3690
Practice Address - Street 1:2800 WESTSIDE DR NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3501
Practice Address - Country:US
Practice Address - Phone:423-339-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DD0317OtherRAILROAD MEDICARE
TNG07385Medicare UPIN
TN3728734Medicare PIN