Healthcare Provider Details

I. General information

NPI: 1912561549
Provider Name (Legal Business Name): JARED WADE BARTON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 11/27/2023
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2358 LIFESTYLE WAY STE 212
CHATTANOOGA TN
37421-4904
US

IV. Provider business mailing address

136 BATTLEFIELD CROSSING CT
RINGGOLD GA
30736-5176
US

V. Phone/Fax

Practice location:
  • Phone: 423-521-1100
  • Fax: 423-521-1200
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 Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: