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General NPI Number Information
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NPI Number | 1316052624
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Entity Type | Organization
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Legal Business Name | KERRY D. FRIESEN, M.D. PC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7405 SHALLOWFORD RD SUITE 270
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City | CHATTANOOGA
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State | TN
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Zip | 37421-2661
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Country | US
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Telephone | 423-553-9995
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Fax | 423-553-9966
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Provider Business Mailing Address
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Address Line | 7405 SHALLOWFORD RD SUITE 270
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City | CHATTANOOGA
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State | TN
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Zip | 37421-2661
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Country | US
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Telephone | 423-553-9995
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Fax | 423-553-9966
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Authorized Official
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Title or Position | OWNER
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Name | KERRY D FRIESEN
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Credential | M.D.
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Telephone | 423-553-9995
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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 | 27073
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License Number State | TN
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