Healthcare Provider Details

I. General information

NPI: 1821132580
Provider Name (Legal Business Name): ALAN EUGENE KOHRT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 BLACKFORD ST
CHATTANOOGA TN
37403-1405
US

IV. Provider business mailing address

9136 STONEY MOUNTAIN DR
CHATTANOOGA TN
37421-2094
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-6185
  • Fax: 423-778-6020
Mailing address:
  • Phone: 423-778-6185
  • Fax: 423-778-6020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number057124
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD0000044551
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: