Healthcare Provider Details

I. General information

NPI: 1750570974
Provider Name (Legal Business Name): HEAD & NECK SPECIALTIES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 GUNBARREL RD SUITE 301
CHATTANOOGA TN
37421-7137
US

IV. Provider business mailing address

1755 GUNBARREL RD SUITE 301
CHATTANOOGA TN
37421-7137
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-8582
  • Fax: 423-778-8594
Mailing address:
  • Phone: 423-778-8582
  • Fax: 423-778-8594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberMD021123
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD008053
License Number StateTN

VIII. Authorized Official

Name: DR. DAVID R BARNES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 423-778-8582