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General NPI Number Information
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NPI Number | 1063163392
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE MEDICINE LLC
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Dates
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Enumeration Date | 01/18/2022
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Last Update Date | 03/29/2022
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Provider Practice Location Address
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Address Line | 8705 E BRAINERD RD STE 1
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City | CHATTANOOGA
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State | TN
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Zip | 37421-4416
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Country | US
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Telephone | 423-316-3334
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Fax |
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Provider Business Mailing Address
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Address Line | 8705 E BRAINERD RD STE 1
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City | CHATTANOOGA
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State | TN
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Zip | 37421-4416
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Country | US
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Telephone | 863-602-6698
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SUKANT GUPTA
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Credential |
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Telephone | 863-602-6698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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