Healthcare Provider Details

I. General information

NPI: 1245537299
Provider Name (Legal Business Name): JONATHAN LAYTON HUMBERD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2011
Last Update Date: 10/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 SPRING CREEK RD
CHATTANOOGA TN
37412-3909
US

IV. Provider business mailing address

941 SPRING CREEK RD
CHATTANOOGA TN
37412-3909
US

V. Phone/Fax

Practice location:
  • Phone: 423-894-7870
  • Fax:
Mailing address:
  • Phone: 423-894-7870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2544
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2544
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: