Healthcare Provider Details

I. General information

NPI: 1760462261
Provider Name (Legal Business Name): WENDELL MOSES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E 3RD ST
CHATTANOOGA TN
37403-2101
US

IV. Provider business mailing address

900 E 3RD ST
CHATTANOOGA TN
37403-2101
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-5437
  • Fax: 423-778-7507
Mailing address:
  • Phone: 423-778-5437
  • Fax: 423-778-7507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number35885
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: