Healthcare Provider Details

I. General information

NPI: 1205143187
Provider Name (Legal Business Name): JOHN STEWART CARDEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3372 KEITH ST NW
CLEVELAND TN
37312-3718
US

IV. Provider business mailing address

2372 LIFESTYLE WAY STE 152
CHATTANOOGA TN
37421-4940
US

V. Phone/Fax

Practice location:
  • Phone: 423-476-4751
  • Fax: 423-339-2692
Mailing address:
  • Phone: 423-894-0432
  • Fax: 423-894-0475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: