Healthcare Provider Details

I. General information

NPI: 1972770063
Provider Name (Legal Business Name): STEPHEN V. DRESKIN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 WESTSIDE DR NW SUITE 306
CLEVELAND TN
37312-3699
US

IV. Provider business mailing address

1949 GUNBARREL RD SUITE 125
CHATTANOOGA TN
37421-3188
US

V. Phone/Fax

Practice location:
  • Phone: 423-664-4635
  • Fax: 423-664-4640
Mailing address:
  • Phone: 423-664-4635
  • Fax: 423-664-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number26298
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number26240
License Number StateTN

VIII. Authorized Official

Name: MRS. CAROL S CLAPP
Title or Position: BILLING MANAGER
Credential: EMT, CMA, CPC
Phone: 423-664-4635