Healthcare Provider Details

I. General information

NPI: 1700394863
Provider Name (Legal Business Name): STARLING MEDICAL PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2018
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E 3RD ST STE 100
CHATTANOOGA TN
37403-2148
US

IV. Provider business mailing address

PO BOX 309
HIXSON TN
37343-0309
US

V. Phone/Fax

Practice location:
  • Phone: 423-870-1662
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARWAN MOUGHRABI
Title or Position: CO-OWNER
Credential: NP
Phone: 423-870-1662