Healthcare Provider Details

I. General information

NPI: 1508084864
Provider Name (Legal Business Name): PRAMEET JAGDISH BHUSHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 SHALLOWFORD RD
CHATTANOOGA TN
37421-5406
US

IV. Provider business mailing address

6401 SHALLOWFORD RD
CHATTANOOGA TN
37421-5406
US

V. Phone/Fax

Practice location:
  • Phone: 423-893-6500
  • Fax:
Mailing address:
  • Phone: 423-899-6500
  • Fax: 423-899-5688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number42130
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number057776
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number42130
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: