Healthcare Provider Details

I. General information

NPI: 1598872632
Provider Name (Legal Business Name): THOMAS MARION BEAHM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1949 GUNBARREL RD SUITE 100
CHATTANOOGA TN
37421-3186
US

IV. Provider business mailing address

PO BOX 28415
CHATTANOOGA TN
37424-8415
US

V. Phone/Fax

Practice location:
  • Phone: 423-485-9200
  • Fax: 423-485-9204
Mailing address:
  • Phone: 423-485-9200
  • Fax: 423-485-9204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number14704
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: