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General NPI Number Information
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NPI Number | 1053196485
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Entity Type | Individual
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Provider Name | DR. KENDAL EMANUEL ORTIZ
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Gender | Male
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Dates
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Enumeration Date | 08/24/2023
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Last Update Date | 08/24/2023
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Provider Practice Location Address
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Address Line | 4700 TENNESSEE AVE # 58
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City | CHATTANOOGA
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State | TN
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Zip | 37409-1837
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Country | US
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Telephone | 423-892-8803
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Fax |
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Provider Business Mailing Address
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Address Line | 902 LIDDELL ST
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City | DALTON
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State | GA
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Zip | 30720-8314
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Country | US
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Telephone | 762-209-1204
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 47404
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License Number State | TN
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