Healthcare Provider Details

I. General information

NPI: 1467794909
Provider Name (Legal Business Name): BSMD CHATTANOOGA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 GUNBARREL RD STE 111
CHATTANOOGA TN
37421-3897
US

IV. Provider business mailing address

PO BOX 321
SYLVA NC
28779-0321
US

V. Phone/Fax

Practice location:
  • Phone: 423-553-5999
  • Fax: 423-553-5640
Mailing address:
  • Phone: 828-586-8160
  • Fax: 828-586-8209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34464
License Number StateTN

VIII. Authorized Official

Name: RUTH MARTIKAINEN
Title or Position: BILLING DIRECTOR
Credential:
Phone: 828-339-7253