Provider Demographics
NPI:1104307693
Name:MDP MANAGEMENT LLC
Entity type:Organization
Organization Name:MDP MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MISTI
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:423-778-5179
Mailing Address - Street 1:1067 RIVERFRONT PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-2222
Mailing Address - Country:US
Mailing Address - Phone:423-602-9530
Mailing Address - Fax:423-602-9529
Practice Address - Street 1:1067 RIVERFRONT PKWY STE 201
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-2222
Practice Address - Country:US
Practice Address - Phone:423-602-9530
Practice Address - Fax:423-602-9529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3842798Medicaid