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General NPI Number Information
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NPI Number | 1063504108
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Entity Type | Individual
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Provider Name | BRETT DAVID MCDONOUGH OD
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Gender | Male
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 04/12/2012
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Provider Practice Location Address
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Address Line | 2020 GUNBARREL ROAD SUITE 100E
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City | CHATTANOOGA
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State | TN
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Zip | 34742-2663
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Country | US
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Telephone | 423-899-9125
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Fax | 423-899-9030
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Provider Business Mailing Address
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Address Line | PO BOX 21821
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City | CHATTANOOGA
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State | TN
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Zip | 37424-0821
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Country | US
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Telephone | 423-899-9125
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Fax | 423-899-9030
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | ODT1825
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License Number State | TN
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