Healthcare Provider Details

I. General information

NPI: 1023461274
Provider Name (Legal Business Name): SAMUEL IGBINEDION
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 E 3RD ST
CHATTANOOGA TN
37403-2163
US

IV. Provider business mailing address

975 E 3RD ST
CHATTANOOGA TN
37403-2163
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-4830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number67398
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: