Healthcare Provider Details

I. General information

NPI: 1093941635
Provider Name (Legal Business Name): GARY EDWARD DECESARE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 COWART ST STE 201
CHATTANOOGA TN
37408-1178
US

IV. Provider business mailing address

1405 COWART ST STE 201
CHATTANOOGA TN
37408-1178
US

V. Phone/Fax

Practice location:
  • Phone: 423-220-3596
  • Fax:
Mailing address:
  • Phone: 423-220-3596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number88698
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME123142
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: