Provider Demographics
NPI:1811912751
Name:WAMACK, CLAUDE JASON (DPM)
Entity type:Individual
Prefix:DR
First Name:CLAUDE
Middle Name:JASON
Last Name:WAMACK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 MCCALLIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3322
Mailing Address - Country:US
Mailing Address - Phone:423-624-2696
Mailing Address - Fax:423-622-6249
Practice Address - Street 1:2415 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3322
Practice Address - Country:US
Practice Address - Phone:423-624-2696
Practice Address - Fax:423-622-6249
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN623213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5212310002Medicare NSC
TN5212310001Medicare NSC
TN5212310002Medicare PIN
TN5212310001Medicare PIN
TNU99612Medicare UPIN
TN3354001Medicare PIN