Healthcare Provider Details

I. General information

NPI: 1104892017
Provider Name (Legal Business Name): MUNFORD RADFORD YATES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E 3RD ST STE 200
CHATTANOOGA TN
37404-2745
US

IV. Provider business mailing address

4976 ALPHA LN
HIXSON TN
37343-5470
US

V. Phone/Fax

Practice location:
  • Phone: 423-643-2500
  • Fax: 423-305-7822
Mailing address:
  • Phone: 423-308-0280
  • Fax: 423-308-0281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number34041
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: