Provider Demographics
NPI:1962822981
Name:DAVID C. REDD, MD, P.C.
Entity Type:Organization
Organization Name:DAVID C. REDD, MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGAER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDY
Authorized Official - Middle Name:E
Authorized Official - Last Name:REDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-622-3191
Mailing Address - Street 1:2205 MCCALLIE AVE STE 507
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:423-622-3191
Mailing Address - Fax:423-622-3192
Practice Address - Street 1:2205 MCCALLIE AVE STE 507
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:423-622-3191
Practice Address - Fax:423-622-3192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC70958208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3811546Medicare UPIN