Healthcare Provider Details

I. General information

NPI: 1497754733
Provider Name (Legal Business Name): GREGG S SHANDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CITICO AVE
CHATTANOOGA TN
37404-1127
US

IV. Provider business mailing address

2501 CITICO AVE
CHATTANOOGA TN
37404-1127
US

V. Phone/Fax

Practice location:
  • Phone: 423-697-2000
  • Fax: 423-697-2118
Mailing address:
  • Phone: 423-697-2000
  • Fax: 423-697-2118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number30751
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number307514
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: