Provider Demographics
NPI:1831268960
Name:WORTMAN, PATRICK ALLEN (RD)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:ALLEN
Last Name:WORTMAN
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 BROOK HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-6219
Mailing Address - Country:US
Mailing Address - Phone:423-847-1563
Mailing Address - Fax:
Practice Address - Street 1:1100 E 3RD ST
Practice Address - Street 2:SUITE G100
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2201
Practice Address - Country:US
Practice Address - Phone:423-643-1970
Practice Address - Fax:423-643-2030
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1614133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered