Healthcare Provider Details

I. General information

NPI: 1437493277
Provider Name (Legal Business Name): CHAD HARLIN GNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2012
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 PROSPECT CHURCH RD
OOLTEWAH TN
37363-8448
US

IV. Provider business mailing address

3811 PROSPECT CHURCH RD
OOLTEWAH TN
37363-8448
US

V. Phone/Fax

Practice location:
  • Phone: 423-645-2481
  • Fax:
Mailing address:
  • Phone: 423-645-2481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number124027
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number33674
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberGAA-NP003042
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: