Healthcare Provider Details

I. General information

NPI: 1568499705
Provider Name (Legal Business Name): CAROLYN DRAKE REISMAN CPM-TN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 BELVOIR AVE
CHATTANOOGA TN
37412-2602
US

IV. Provider business mailing address

606 BELVOIR AVE
CHATTANOOGA TN
37412-2602
US

V. Phone/Fax

Practice location:
  • Phone: 423-622-4226
  • Fax:
Mailing address:
  • Phone: 423-622-4226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number39
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: