Healthcare Provider Details

I. General information

NPI: 1770022949
Provider Name (Legal Business Name): RYAN LITCHFIELD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 CHURCH ST
PIKEVILLE TN
37367-5643
US

IV. Provider business mailing address

525 BATTERY PL APT 9
CHATTANOOGA TN
37403-1249
US

V. Phone/Fax

Practice location:
  • Phone: 423-447-2992
  • Fax:
Mailing address:
  • Phone: 423-413-1934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3226
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: