Healthcare Provider Details

I. General information

NPI: 1528040425
Provider Name (Legal Business Name): JESSIE LANETT VARNELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 DESALES AVE
CHATTANOOGA TN
37404-1161
US

IV. Provider business mailing address

601 DODDS AVE
CHATTANOOGA TN
37404-3911
US

V. Phone/Fax

Practice location:
  • Phone: 423-495-4430
  • Fax: 423-495-6179
Mailing address:
  • Phone: 423-629-9783
  • Fax: 423-698-3622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD0000035919
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: