Healthcare Provider Details

I. General information

NPI: 1720916893
Provider Name (Legal Business Name): JACKSON DAVID ATTEBERRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2347 ROSSVILLE BLVD
CHATTANOOGA TN
37408-2250
US

IV. Provider business mailing address

1401 MARKET ST APT 208
CHATTANOOGA TN
37402-4438
US

V. Phone/Fax

Practice location:
  • Phone: 423-509-0763
  • Fax:
Mailing address:
  • Phone: 865-202-1914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: