Healthcare Provider Details

I. General information

NPI: 1699722421
Provider Name (Legal Business Name): MARWAN M MOUGHRABI NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 ALPHA LN
HIXSON TN
37343-4054
US

IV. Provider business mailing address

PO BOX 22696
CHATTANOOGA TN
37422-2696
US

V. Phone/Fax

Practice location:
  • Phone: 423-870-1662
  • Fax: 423-877-4845
Mailing address:
  • Phone: 423-870-1662
  • Fax: 423-877-4845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN0000006183
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: