Healthcare Provider Details

I. General information

NPI: 1417970054
Provider Name (Legal Business Name): JACK M. ROWLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 GUNBARREL RD STE 111
CHATTANOOGA TN
37421-3897
US

IV. Provider business mailing address

1511 GUNBARREL RD STE 111
CHATTANOOGA TN
37421-3897
US

V. Phone/Fax

Practice location:
  • Phone: 423-553-5999
  • Fax: 423-602-7456
Mailing address:
  • Phone: 423-553-5999
  • Fax: 423-602-7456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number34464
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: