Healthcare Provider Details

I. General information

NPI: 1700970407
Provider Name (Legal Business Name): PROFESSIONAL MEDICAL PROPERTIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6015 SHALLOWFORD ROAD
CHATTANOOGA TN
37421-1688
US

IV. Provider business mailing address

6015 SHALLOWFORD ROAD
CHATTANOOGA TN
37421-1688
US

V. Phone/Fax

Practice location:
  • Phone: 423-954-9180
  • Fax: 423-954-3054
Mailing address:
  • Phone: 423-893-3333
  • Fax: 423-954-3054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number1224
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. WAYNE E TIPPS
Title or Position: PRESIDENT/PARTNER
Credential: DDS
Phone: 423-893-3333