Healthcare Provider Details

I. General information

NPI: 1588980999
Provider Name (Legal Business Name): JODY LYNN HADDOCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 DESALES AVENUE CHI MEMORIAL HOSPITAL-CHATTANOOGA
CHATTANOOGA TN
37404
US

IV. Provider business mailing address

2525 DESALES AVENUE CHI MEMORIAL HOSPITAL-CHATTANOOGA
CHATTANOOGA TN
37404
US

V. Phone/Fax

Practice location:
  • Phone: 423-495-7404
  • Fax: 423-495-2625
Mailing address:
  • Phone: 423-495-7404
  • Fax: 423-495-2625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number54574
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number01091696A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: