Healthcare Provider Details

I. General information

NPI: 1821282716
Provider Name (Legal Business Name): DAVID SCOTT THOMAS CO OTC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 E ANDREW JOHNSON HWY
GREENEVILLE TN
37745-0948
US

IV. Provider business mailing address

3700 BRAINERD RD
CHATTANOOGA TN
37411-3603
US

V. Phone/Fax

Practice location:
  • Phone: 423-525-5073
  • Fax: 423-525-5349
Mailing address:
  • Phone: 423-697-0057
  • Fax: 423-648-9366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberC16007
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: