Healthcare Provider Details

I. General information

NPI: 1942629969
Provider Name (Legal Business Name): BENJAMIN GEDDES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 MCCALLIE AVE
CHATTANOOGA TN
37404-3322
US

IV. Provider business mailing address

2415 MCCALLIE AVE
CHATTANOOGA TN
37404-3322
US

V. Phone/Fax

Practice location:
  • Phone: 423-624-2696
  • Fax: 423-622-6249
Mailing address:
  • Phone: 423-624-2696
  • Fax: 423-622-6249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number88090
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number52470
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number61037
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: