Healthcare Provider Details

I. General information

NPI: 1598146607
Provider Name (Legal Business Name): JONATHAN NICHOLAS PUMILIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

979 E 3RD ST STE B-601
CHATTANOOGA TN
37403-2136
US

IV. Provider business mailing address

979 E 3RD ST STE B-601
CHATTANOOGA TN
37403-2136
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-8179
  • Fax: 423-778-8180
Mailing address:
  • Phone: 423-778-8179
  • Fax: 423-778-8180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number58494
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number58494
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: