Provider Demographics
NPI:1184610867
Name:ZELLNER, JAMES LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LAWRENCE
Last Name:ZELLNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 CITICO AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1127
Mailing Address - Country:US
Mailing Address - Phone:423-697-2000
Mailing Address - Fax:423-697-2118
Practice Address - Street 1:2108 E 3RD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2605
Practice Address - Country:US
Practice Address - Phone:423-624-5233
Practice Address - Fax:423-624-4440
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34082208G00000X
GA048838208G00000X
SC13478208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3849578Medicaid
G24738Medicare UPIN
TN3849578Medicaid
GAGRP3449Medicare PIN