Healthcare Provider Details

I. General information

NPI: 1942231592
Provider Name (Legal Business Name): SCOTT ALAN RESNICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 N MARKET ST
CHATTANOOGA TN
37405-3908
US

IV. Provider business mailing address

309 N MARKET ST
CHATTANOOGA TN
37405-3908
US

V. Phone/Fax

Practice location:
  • Phone: 423-760-4880
  • Fax: 423-760-4884
Mailing address:
  • Phone: 423-760-4880
  • Fax: 423-760-4884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number51106
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number51106
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: