Healthcare Provider Details

I. General information

NPI: 1992236772
Provider Name (Legal Business Name): WARREN STARRETT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 SPRING CREEK RD
CHATTANOOGA TN
37412-3909
US

IV. Provider business mailing address

818 BOYLSTON ST
CHATTANOOGA TN
37405-2812
US

V. Phone/Fax

Practice location:
  • Phone: 423-894-7870
  • Fax:
Mailing address:
  • Phone: 970-946-8796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3297
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: