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General NPI Number Information
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NPI Number | 1548332166
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Entity Type | Individual
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Provider Name | GARY MARTIN EDGMON DDS MS
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Gender | Male
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 03/20/2019
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Provider Practice Location Address
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Address Line | 7003 SHALLOWFORD RD STE 201
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City | CHATTANOOGA
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State | TN
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Zip | 37421
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Country | US
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Telephone | 423-541-1850
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Fax |
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Provider Business Mailing Address
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Address Line | 7003 SHALLOWFORD RD STE 201
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City | CHATTANOOGA
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State | TN
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Zip | 37421-6722
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 09156
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 10198
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License Number State | TN
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