Healthcare Provider Details

I. General information

NPI: 1285627265
Provider Name (Legal Business Name): RADIAN I FLOREA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 11/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 DESALES AVE
CHATTANOOGA TN
37404-1161
US

IV. Provider business mailing address

100 GROSS CRESCENT CIR
FT OGLETHORPE GA
30742-3643
US

V. Phone/Fax

Practice location:
  • Phone: 423-495-7404
  • Fax:
Mailing address:
  • Phone: 706-858-2101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number049171
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number41259
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: