Healthcare Provider Details

I. General information

NPI: 1740735992
Provider Name (Legal Business Name): KEVIN ANDREW TAWZER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2358 LIFESTYLE WAY SUITE 212
CHATTANOOGA TN
37421-2291
US

IV. Provider business mailing address

136 BATTLEFIELD CROSSING CT
RINGGOLD GA
30736-5176
US

V. Phone/Fax

Practice location:
  • Phone: 423-521-1104
  • Fax:
Mailing address:
  • Phone: 706-277-7311
  • Fax: 706-529-7210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0000002930
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: