Healthcare Provider Details

I. General information

NPI: 1508174210
Provider Name (Legal Business Name): JOHN D ALEXANDER CO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 BRAINERD RD
CHATTANOOGA TN
37411-3603
US

IV. Provider business mailing address

3700 BRAINERD RD
CHATTANOOGA TN
37411-3603
US

V. Phone/Fax

Practice location:
  • Phone: 423-697-0057
  • Fax: 423-648-9366
Mailing address:
  • Phone: 423-697-0057
  • Fax: 423-648-9366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCO004822
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: