Healthcare Provider Details

I. General information

NPI: 1427092949
Provider Name (Legal Business Name): NORMA J SPARKS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 E 12TH ST
SOUTH PITTSBURG TN
37380-1630
US

IV. Provider business mailing address

6170 SHALLOWFORD RD 101
CHATTANOOGA TN
37421-1892
US

V. Phone/Fax

Practice location:
  • Phone: 423-648-4460
  • Fax: 423-648-4461
Mailing address:
  • Phone: 423-648-4500
  • Fax: 423-855-7563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0000000073
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: