Healthcare Provider Details

I. General information

NPI: 1265570600
Provider Name (Legal Business Name): TENNESEE DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 RIVERSIDE DR STE 120
CHATTANOOGA TN
37406-4332
US

IV. Provider business mailing address

1301 RIVERFRONT PKWY STE 209
CHATTANOOGA TN
37402-3312
US

V. Phone/Fax

Practice location:
  • Phone: 423-634-3110
  • Fax: 423-634-5848
Mailing address:
  • Phone: 423-634-5832
  • Fax: 423-634-3186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD WAYNE MCCARTHY
Title or Position: ACCOUNTING MANAGER
Credential: MBA
Phone: 423-634-5832