Healthcare Provider Details

I. General information

NPI: 1033154398
Provider Name (Legal Business Name): ROBERT R SCIULLI JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 N LYERLY ST STE 200
CHATTANOOGA TN
37404-2749
US

IV. Provider business mailing address

281 N LYERLY ST STE 200
CHATTANOOGA TN
37404-2749
US

V. Phone/Fax

Practice location:
  • Phone: 423-698-0850
  • Fax: 423-698-0511
Mailing address:
  • Phone: 423-698-0850
  • Fax: 423-698-0511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1604
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: