Provider Demographics
NPI:1720069578
Name:INGRAM NUNALLY, BESSIE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:BESSIE
Middle Name:ANN
Last Name:INGRAM NUNALLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 N LYERLY ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2728
Mailing Address - Country:US
Mailing Address - Phone:423-648-7770
Mailing Address - Fax:423-648-7772
Practice Address - Street 1:251 N LYERLY ST STE 300
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2728
Practice Address - Country:US
Practice Address - Phone:423-648-7770
Practice Address - Fax:423-648-7772
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24208207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3080588Medicaid
F74426Medicare UPIN
TN3080584Medicare ID - Type Unspecified