Healthcare Provider Details

I. General information

NPI: 1093780546
Provider Name (Legal Business Name): H JOSEPH LANTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 GUNBARREL RD SUITE 301
CHATTANOOGA TN
37421-7137
US

IV. Provider business mailing address

1755 GUNBARREL RD SUITE 301
CHATTANOOGA TN
37421-7137
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-8582
  • Fax: 423-778-8594
Mailing address:
  • Phone: 423-778-8582
  • Fax: 423-778-8594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD0000021123
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: