Healthcare Provider Details

I. General information

NPI: 1902049836
Provider Name (Legal Business Name): ANDERS EUGENE PETERSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 E 3RD ST
CHATTANOOGA TN
37403-2147
US

IV. Provider business mailing address

8193 BIGGS RD
OOLTEWAH TN
37363-9503
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number47929
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: