Healthcare Provider Details

I. General information

NPI: 1437148152
Provider Name (Legal Business Name): DIAGNOSTIC CARDIOLOGY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2341 MCCALLIE AVE PLAZA 3, STE. 200
CHATTANOOGA TN
37404-3239
US

IV. Provider business mailing address

2341 MCCALLIE AVE PLAZA 3, STE. 200
CHATTANOOGA TN
37404-3239
US

V. Phone/Fax

Practice location:
  • Phone: 423-629-4106
  • Fax: 423-629-4116
Mailing address:
  • Phone: 423-629-4106
  • Fax: 423-629-4116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: THEODORE RICHARDS
Title or Position: CEO
Credential: MD
Phone: 423-629-4106