Healthcare Provider Details

I. General information

NPI: 1003894148
Provider Name (Legal Business Name): MARTIN THOMAS KRECKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5022 OLD GODSEY LN SUITE 10
HIXSON TN
37343-6600
US

IV. Provider business mailing address

5022 OLD GODSEY LN SUITE 10
HIXSON TN
37343-6600
US

V. Phone/Fax

Practice location:
  • Phone: 423-870-0558
  • Fax: 423-870-4513
Mailing address:
  • Phone: 423-870-0558
  • Fax: 423-870-4513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMD0000029095
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: