Healthcare Provider Details

I. General information

NPI: 1326743717
Provider Name (Legal Business Name): KERIGAN GREEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 11/04/2026
Certification Date: 11/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3328 JENKINS RD STE 200
CHATTANOOGA TN
37421-1298
US

IV. Provider business mailing address

3328 JENKINS RD STE 200
CHATTANOOGA TN
37421-1298
US

V. Phone/Fax

Practice location:
  • Phone: 423-825-4040
  • Fax:
Mailing address:
  • Phone: 423-825-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number247482
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: