Healthcare Provider Details

I. General information

NPI: 1386179513
Provider Name (Legal Business Name): ELIZABETH ANNE SEAGRAVES BROOKE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 KIRBY AVE
CHATTANOOGA TN
37404-3523
US

IV. Provider business mailing address

1740 KIRBY AVE
CHATTANOOGA TN
37404-3523
US

V. Phone/Fax

Practice location:
  • Phone: 336-953-1293
  • Fax:
Mailing address:
  • Phone: 336-953-1293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number65880
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25IA12591400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD487082C
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number45942
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number65880
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: