Healthcare Provider Details

I. General information

NPI: 1811964554
Provider Name (Legal Business Name): SCOTT R. KEMMERER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 GUNBARREL RD
CHATTANOOGA TN
37421-3125
US

IV. Provider business mailing address

1604 GUNBARREL RD
CHATTANOOGA TN
37421-3125
US

V. Phone/Fax

Practice location:
  • Phone: 423-893-7226
  • Fax: 423-893-7398
Mailing address:
  • Phone: 423-648-2395
  • Fax: 423-648-7542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number34995
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number049910
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number049910
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number34995
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number34995
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number049910
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: