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General NPI Number Information
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NPI Number | 1427092949
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Entity Type | Individual
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Provider Name | NORMA J SPARKS PA
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Gender | Female
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 04/01/2008
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Provider Practice Location Address
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Address Line | 625 E 12TH ST
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City | SOUTH PITTSBURG
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State | TN
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Zip | 37380-1630
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Country | US
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Telephone | 423-648-4460
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Fax | 423-648-4461
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Provider Business Mailing Address
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Address Line | 6170 SHALLOWFORD RD 101
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City | CHATTANOOGA
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State | TN
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Zip | 37421-1892
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Country | US
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Telephone | 423-648-4500
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Fax | 423-855-7563
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA0000000073
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License Number State | TN
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