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General NPI Number Information
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NPI Number | 1689959561
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Entity Type | Individual
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Provider Name | NICHOLAS J PONS PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/11/2011
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 2525 DESALES AVENUE
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City | CHATTANOOGA
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State | TN
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Zip | 37404
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Country | US
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Telephone | 423-697-0014
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Fax | 423-648-6280
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Provider Business Mailing Address
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Address Line | 725 GLENWOOD DRIVE SUITE E-487
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City | CHATTANOOGA
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State | TN
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Zip | 37404
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Country | US
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Telephone | 423-697-0014
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Fax | 423-648-6280
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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 | 2027
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License Number State | TN
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