Healthcare Provider Details

I. General information

NPI: 1205124187
Provider Name (Legal Business Name): NEAL J ERHARD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2341 MCCALLIE AVE SUITE 402
CHATTANOOGA TN
37404-3239
US

IV. Provider business mailing address

PO BOX 3549
CHATTANOOGA TN
37404-0549
US

V. Phone/Fax

Practice location:
  • Phone: 423-698-3309
  • Fax: 423-562-4635
Mailing address:
  • Phone: 423-698-3309
  • Fax: 423-624-6355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN148146
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN15928
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: