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General NPI Number Information
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NPI Number | 1649618653
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Entity Type | Individual
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Provider Name | BRANDON JAMES ALLEN BIVENS D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/12/2013
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 2525 DESALES AVE
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City | CHATTANOOGA
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State | TN
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Zip | 37404-1161
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Country | US
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Telephone | 423-495-7404
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Fax |
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Provider Business Mailing Address
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Address Line | 5600 BRAINERD RD STE 500
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City | CHATTANOOGA
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State | TN
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Zip | 37411-5371
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Country | US
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Telephone | 423-495-8659
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 5287
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License Number State | TN
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