Healthcare Provider Details

I. General information

NPI: 1023544871
Provider Name (Legal Business Name): KATHERINE S MCCLELLAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 BATTLEFIELD PKWY STE 200
RINGGOLD GA
30736-5168
US

IV. Provider business mailing address

1949 GUNBARREL RD STE 206
CHATTANOOGA TN
37421-7133
US

V. Phone/Fax

Practice location:
  • Phone: 706-861-4990
  • Fax: 706-861-9405
Mailing address:
  • Phone: 423-495-4345
  • Fax: 423-495-4934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number61985
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number38347
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number86815
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: