Healthcare Provider Details

I. General information

NPI: 1053305789
Provider Name (Legal Business Name): DANIEL FRANKLIN FISHER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 E 3RD ST SUITE 200
CHATTANOOGA TN
37404-2600
US

IV. Provider business mailing address

979 E 3RD ST STE 300
CHATTANOOGA TN
37403-2136
US

V. Phone/Fax

Practice location:
  • Phone: 423-267-0466
  • Fax: 423-778-8212
Mailing address:
  • Phone: 423-267-0466
  • Fax: 423-778-8212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD9631
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number9631
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: