Healthcare Provider Details

I. General information

NPI: 1609965656
Provider Name (Legal Business Name): SOUTHERN REHABILITATION GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 SPRING CREEK RD
CHATTANOOGA TN
37412-3970
US

IV. Provider business mailing address

1011 SPRING CREEK RD
CHATTANOOGA TN
37412-3970
US

V. Phone/Fax

Practice location:
  • Phone: 423-510-0092
  • Fax: 866-723-8928
Mailing address:
  • Phone: 423-510-0092
  • Fax: 866-723-8928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number15701
License Number StateTN

VIII. Authorized Official

Name: DR. JAMES PETER LITTLE
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 423-510-0092