Healthcare Provider Details

I. General information

NPI: 1619056462
Provider Name (Legal Business Name): STEPHEN V DRESKIN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6130 SHALLOWFORD RD STE 101
CHATTANOOGA TN
37421-7222
US

IV. Provider business mailing address

6130 SHALLOWFORD RD STE 101
CHATTANOOGA TN
37421-7222
US

V. Phone/Fax

Practice location:
  • Phone: 423-664-4635
  • Fax: 423-664-4640
Mailing address:
  • Phone: 423-664-4635
  • Fax: 423-664-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number26298
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number26240
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number846
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11764
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN8476
License Number StateTN
# 7
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMBER GENTER
Title or Position: MANAGER
Credential:
Phone: 423-664-4635