Healthcare Provider Details

I. General information

NPI: 1962487157
Provider Name (Legal Business Name): TIM VERNON LARSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TIM LARSON MD

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 BRAINERD RD STE A4
CHATTANOOGA TN
37411-5336
US

IV. Provider business mailing address

1923 SULPHUR SPRINGS RD
MORRISTOWN TN
37813-5654
US

V. Phone/Fax

Practice location:
  • Phone: 423-266-4588
  • Fax: 865-342-0103
Mailing address:
  • Phone: 423-317-9344
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD29692
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: