Healthcare Provider Details

I. General information

NPI: 1316473366
Provider Name (Legal Business Name): SILVERSAGE PHYSICIAN SERVICES OF TENNESSEE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 06/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5911 SNOW HILL RD
OOLTEWAH TN
37363-9129
US

IV. Provider business mailing address

P.O. BOX 23993
CHATTANOOGA TN
37422-3993
US

V. Phone/Fax

Practice location:
  • Phone: 423-531-0600
  • Fax: 423-531-0645
Mailing address:
  • Phone: 423-815-1600
  • Fax: 423-763-1118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH L. SCOTT JR.
Title or Position: OWNER AND PRESIDENT
Credential: D.O.
Phone: 423-815-1605