Healthcare Provider Details

I. General information

NPI: 1922075001
Provider Name (Legal Business Name): DAVID MARSHALL JEMISON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

979 E 3RD ST SUITE C920
CHATTANOOGA TN
37403-2136
US

IV. Provider business mailing address

979 E 3RD ST SUITE C920
CHATTANOOGA TN
37403-2136
US

V. Phone/Fax

Practice location:
  • Phone: 423-756-7134
  • Fax: 423-763-4571
Mailing address:
  • Phone: 423-756-7134
  • Fax: 423-763-4571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number15654
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: