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General NPI Number Information
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NPI Number | 1215481023
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Entity Type | Individual
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Provider Name | MARK ANTHONY DUGGER FNP-C
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Gender | Male
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Dates
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Enumeration Date | 08/09/2016
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Last Update Date | 08/09/2016
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Provider Practice Location Address
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Address Line | 7446 SHALLOWFORD RD SUITE 114
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City | CHATTANOOGA
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State | TN
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Zip | 37421-8815
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Country | US
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Telephone | 423-933-2001
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Fax |
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Provider Business Mailing Address
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Address Line | 3411 KELLYS FERRY RD
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City | CHATTANOOGA
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State | TN
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Zip | 37419-2013
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Country | US
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Telephone | 423-505-4456
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 21505
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License Number State | TN
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