Healthcare Provider Details

I. General information

NPI: 1669559035
Provider Name (Legal Business Name): MARK P ELAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9702 CHESTNUT HILL LN
CHATTANOOGA TN
37421-4815
US

IV. Provider business mailing address

208 WOODLAND AVE
CHATTANOOGA TN
37405-3959
US

V. Phone/Fax

Practice location:
  • Phone: 706-226-5446
  • Fax: 866-230-8698
Mailing address:
  • Phone: 706-483-4999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number036147
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: