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General NPI Number Information
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NPI Number | 1427586783
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Entity Type | Individual
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Provider Name | GHAITH AL-SOWAIDI
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Gender | Male
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Dates
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Enumeration Date | 05/31/2017
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Last Update Date | 09/22/2017
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Provider Practice Location Address
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Address Line | 2100 HAMILTON PLACE BLVD STE 167
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City | CHATTANOOGA
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State | TN
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Zip | 37421-6057
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Country | US
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Telephone | 423-892-7166
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Fax |
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Provider Business Mailing Address
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Address Line | 6111 NASHVILLE HWY
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City | DEER LODGE
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State | TN
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Zip | 37726-3219
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Country | US
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Telephone |
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3389
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License Number State | TN
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