Healthcare Provider Details

I. General information

NPI: 1194393025
Provider Name (Legal Business Name): WESLEY DANIEL PETERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 DESALES AVE
CHATTANOOGA TN
37404-1161
US

IV. Provider business mailing address

1924 ALCOA HWY # U-109
KNOXVILLE TN
37920-1511
US

V. Phone/Fax

Practice location:
  • Phone: 423-495-2525
  • Fax: 423-495-6312
Mailing address:
  • Phone: 865-305-9220
  • Fax: 865-305-9216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number66641
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMMD.86313
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: