Healthcare Provider Details

I. General information

NPI: 1639794258
Provider Name (Legal Business Name): JOSEPH ANDREW MOORE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
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: 423-497-5355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number76496
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: