Provider Demographics
NPI:1649332859
Name:BIRD, JOSEPH SIMMONS JR (MD)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:SIMMONS
Last Name:BIRD
Suffix:JR
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:P.O. BOX 21867
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37424-0867
Mailing Address - Country:US
Mailing Address - Phone:423-899-0500
Mailing Address - Fax:423-899-2411
Practice Address - Street 1:7407 ZIEGLER ROAD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3157
Practice Address - Country:US
Practice Address - Phone:423-899-0500
Practice Address - Fax:423-899-2411
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD021612207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4111334OtherBLUE CROSS OF TENNESSEE
TN4111334OtherBCBS
TN74-40035OtherUNITED HEALTHCARE
TN3062963Medicaid
TN141932371OtherTAX IDENTIFICATION
TN74-40035OtherUHC