Healthcare Provider Details

I. General information

NPI: 1396983763
Provider Name (Legal Business Name): DAVID W ADCOCK MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 05/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 N LYERLY ST SUITE 200
CHATTANOOGA TN
37404-2728
US

IV. Provider business mailing address

251 N LYERLY ST SUITE 200
CHATTANOOGA TN
37404-2728
US

V. Phone/Fax

Practice location:
  • Phone: 423-648-5525
  • Fax: 423-648-5240
Mailing address:
  • Phone: 423-648-5525
  • Fax: 423-648-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD0000020999
License Number StateTN

VIII. Authorized Official

Name: DAVID WILLIAM ADCOCK
Title or Position: OWNER
Credential: M.D.
Phone: 423-648-5525