Healthcare Provider Details

I. General information

NPI: 1699829226
Provider Name (Legal Business Name): BRENDA K. SOWTER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 MAIN ST
KIMBALL TN
37347-5551
US

IV. Provider business mailing address

PO BOX 81118
CHATTANOOGA TN
37414-8318
US

V. Phone/Fax

Practice location:
  • Phone: 423-837-6000
  • Fax: 423-837-6009
Mailing address:
  • Phone: 423-899-2204
  • Fax: 423-698-4045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO0000001174
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: