Healthcare Provider Details

I. General information

NPI: 1437524683
Provider Name (Legal Business Name): THE VEIN INSTITUTE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2015
Last Update Date: 04/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 COWART ST STE 321
CHATTANOOGA TN
37408-1127
US

IV. Provider business mailing address

1405 COWART ST STE 321
CHATTANOOGA TN
37408-1127
US

V. Phone/Fax

Practice location:
  • Phone: 423-551-8346
  • Fax: 423-551-8347
Mailing address:
  • Phone: 423-551-8346
  • Fax: 423-551-8347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: VINCENT WAYNE GARDNER
Title or Position: OWNER
Credential: MD
Phone: 423-551-8346