Provider Demographics
NPI:1891732053
Name:SLEDGE, JOSEPH WALTER III (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WALTER
Last Name:SLEDGE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11426
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401-2426
Mailing Address - Country:US
Mailing Address - Phone:423-877-2312
Mailing Address - Fax:423-877-5855
Practice Address - Street 1:2339 MCCALLIE AVE
Practice Address - Street 2:PLAZA 2 STE 204
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3256
Practice Address - Country:US
Practice Address - Phone:423-629-6995
Practice Address - Fax:423-629-6641
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD24377207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNC86687Medicare UPIN
TN3075268Medicare ID - Type Unspecified