Healthcare Provider Details

I. General information

NPI: 1225712748
Provider Name (Legal Business Name): ELIJAH LEVI ATKINSON APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2290 OGLETREE AVE
CHATTANOOGA TN
37421-8816
US

IV. Provider business mailing address

1015 AMELIA CT
EAST RIDGE TN
37412-2477
US

V. Phone/Fax

Practice location:
  • Phone: 913-704-9573
  • Fax:
Mailing address:
  • Phone: 913-704-9574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number34069
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5022877
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: