Healthcare Provider Details

I. General information

NPI: 1457315848
Provider Name (Legal Business Name): JUDITH J BOGGESS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: J JOY BOGGESS M.D.

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 11/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 TOMBRAS AVE
EAST RIDGE TN
37412-2720
US

IV. Provider business mailing address

1508 TOMBRAS AVE
EAST RIDGE TN
37412-2720
US

V. Phone/Fax

Practice location:
  • Phone: 423-867-4969
  • Fax: 423-805-4213
Mailing address:
  • Phone: 423-867-4969
  • Fax: 423-805-4213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number41642
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: