Healthcare Provider Details

I. General information

NPI: 1255846382
Provider Name (Legal Business Name): DENNIS PROK PA- C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 STEIN DR
CHATTANOOGA TN
37421-1690
US

IV. Provider business mailing address

48TH MDG/ RAF LAKENHEATH UNIT 5115
APO AE
09461-5115
US

V. Phone/Fax

Practice location:
  • Phone: 423-648-8480
  • Fax: 423-648-8481
Mailing address:
  • Phone: 314-226-8268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: