Provider Demographics
NPI:1982690038
Name:SPORTS CARE OF CHATTANOOGA PLLC
Entity Type:Organization
Organization Name:SPORTS CARE OF CHATTANOOGA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:JENKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:423-425-4453
Mailing Address - Street 1:501 HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-3409
Mailing Address - Country:US
Mailing Address - Phone:423-425-4453
Mailing Address - Fax:423-425-2266
Practice Address - Street 1:501 HOUSTON ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-3409
Practice Address - Country:US
Practice Address - Phone:423-425-4453
Practice Address - Fax:423-425-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty