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NPI Code Detail

MEDICARE: DR. BRANDON ELLIS RODGERS PH.D.

MEDICARE: DR. BRANDON ELLIS RODGERS PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistLMT0000000847TN

General Provider Information

NPI Number : 1770816100
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRANDON ELLIS RODGERS PH.D.
Provider Business Mailing Address
First Line : 920 NORFOLK GREEN CIR
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-8216
Country : US
Telephone Number : 423-618-1443
Fax Number :
Provider Business Practice Location Address
First Line : 1101 CARTER ST
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37402-5017
Country : US
Telephone Number : 423-778-6031
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2009
Last Update Date : 07/09/2018

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