Healthcare Provider Details

I. General information

NPI: 1609515683
Provider Name (Legal Business Name): PULMONARY AND SLEEP INSTITUTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5109 BRAINERD RD
CHATTANOOGA TN
37411-3906
US

IV. Provider business mailing address

PO BOX 4099
CHATTANOOGA TN
37405-0099
US

V. Phone/Fax

Practice location:
  • Phone: 423-654-7400
  • Fax: 423-654-7401
Mailing address:
  • Phone: 423-654-7400
  • Fax: 423-654-7401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HARSHA SHANTHAVEERAPPA
Title or Position: PRESIDENT
Credential: MD
Phone: 423-654-7400