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General NPI Number Information
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NPI Number | 1487117313
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Entity Type | Individual
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Provider Name | JEREMY HOGSTROM DO
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Gender | Male
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Dates
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Enumeration Date | 04/08/2019
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Last Update Date | 09/09/2022
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Provider Practice Location Address
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Address Line | 3739 HIXSON PIKE
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City | CHATTANOOGA
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State | TN
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Zip | 37415-3520
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Country | US
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Telephone | 423-875-0999
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Fax | 423-875-0896
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Provider Business Mailing Address
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Address Line | 1949 GUNBARREL RD STE 206
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City | CHATTANOOGA
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State | TN
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Zip | 37421-7133
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Country | US
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Telephone | 423-495-4349
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Fax | 423-495-4934
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4761
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License Number State | TN
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