Healthcare Provider Details

I. General information

NPI: 1609095108
Provider Name (Legal Business Name): JACK M ROWLAND, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
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 TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD0000034464
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD0000034464
License Number State

VIII. Authorized Official

Name: MR. JACK M ROWLAND
Title or Position: OWNER
Credential: MD
Phone: 423-648-6020