Healthcare Provider Details

I. General information

NPI: 1821067430
Provider Name (Legal Business Name): DAVID WATSON RICE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 GLENWOOD DR SUITE 212
CHATTANOOGA TN
37404-1108
US

IV. Provider business mailing address

605 GLENWOOD DR SUITE 212
CHATTANOOGA TN
37404-1108
US

V. Phone/Fax

Practice location:
  • Phone: 423-697-9890
  • Fax: 423-697-9891
Mailing address:
  • Phone: 423-697-9890
  • Fax: 423-697-9891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD0000030486
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number045596
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number00025325
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: