Healthcare Provider Details

I. General information

NPI: 1841712254
Provider Name (Legal Business Name): QLER PHYSICIAN MEDICAL GROUP, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4431 ADRIENNE CT
JEFFERSON MD
21755
US

IV. Provider business mailing address

200 W MARTIN LUTHER KING BLVD
CHATTANOOGA TN
37402-2560
US

V. Phone/Fax

Practice location:
  • Phone: 240-285-5396
  • Fax:
Mailing address:
  • Phone: 240-285-5396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. DWAYNE AVANISH NARAYAN
Title or Position: CHIEF CLINICAL OFFICER
Credential: MD
Phone: 240-285-5396