Healthcare Provider Details

I. General information

NPI: 1578698270
Provider Name (Legal Business Name): KATHLEEN JUDE LOCKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 01/09/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 PARKWOOD AVENUE
CHATTANOOGA TN
37404
US

IV. Provider business mailing address

2717 EAST OAKLAND AVENUE
JOHNSON CITY TN
37601-1843
US

V. Phone/Fax

Practice location:
  • Phone: 423-624-1533
  • Fax: 662-568-3360
Mailing address:
  • Phone: 423-926-2358
  • Fax: 423-926-2680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19614
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: