=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245299551
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD HUNTER JENNINGS III MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2006
-----------------------------------------------------
Last Update Date | 12/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 721 GLENWOOD DR STE 560 MEMORIAL MEDICAL BUILDING WEST
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37404-1129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-622-2494
-----------------------------------------------------
Fax | 423-622-4532
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 721 GLENWOOD DR STE 560 MEMORIAL MEDICAL BUILDING WEST
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37404-1129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-622-2494
-----------------------------------------------------
Fax | 423-622-4532
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 18857
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------