Healthcare Provider Details

I. General information

NPI: 1164955886
Provider Name (Legal Business Name): JUAN SEBASTIAN GARRIDO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 CLEVELAND AVE
CHATTANOOGA TN
37404-2005
US

IV. Provider business mailing address

1300 CLEVELAND AVE
CHATTANOOGA TN
37404-2005
US

V. Phone/Fax

Practice location:
  • Phone: 423-756-7860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1141980
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: