Healthcare Provider Details

I. General information

NPI: 1396786745
Provider Name (Legal Business Name): COLUMBIA MEDICAL GROUP-PARKRIDGE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 01/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 SPRING CREEK RD SUITE 205
CHATTANOOGA TN
37412-3993
US

IV. Provider business mailing address

935 SPRING CREEK RD SUITE 205
CHATTANOOGA TN
37412-3993
US

V. Phone/Fax

Practice location:
  • Phone: 423-893-9787
  • Fax:
Mailing address:
  • Phone: 423-893-9787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHUCK LOCKE
Title or Position: VP
Credential:
Phone: 615-373-7604