Healthcare Provider Details

I. General information

NPI: 1720179567
Provider Name (Legal Business Name): J WALTER SLEDGE MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2339 MCCALLIE AVENUE PLAZA II SUITE 204
CHATTANOOGA TN
37404
US

IV. Provider business mailing address

PO BOX 11426
CHATTANOOGA TN
37401
US

V. Phone/Fax

Practice location:
  • Phone: 423-629-6995
  • Fax: 423-629-6641
Mailing address:
  • Phone: 423-877-2312
  • Fax: 423-877-5855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number24377
License Number StateTN

VIII. Authorized Official

Name: DURIE ANDREWS
Title or Position: BILLING OFFICE OWNER
Credential:
Phone: 423-877-2312