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General NPI Number Information
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NPI Number | 1720120900
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Entity Type | Individual
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Provider Name | JOHN KEVIN GARDNER C.P.
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Gender | Male
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 11/18/2015
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Provider Practice Location Address
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Address Line | 2108 E 3RD ST STE 100
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City | CHATTANOOGA
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State | TN
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Zip | 37404-2623
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Country | US
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Telephone | 423-493-2395
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Fax | 423-493-2368
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Provider Business Mailing Address
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Address Line | 979 E 3RD ST STE 300
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City | CHATTANOOGA
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State | TN
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Zip | 37403-2187
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Country | US
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Telephone | 423-757-0792
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Fax | 423-757-0770
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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 | 224P00000X
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Taxonomy Name | Prosthetist
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License Number | PRO94
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License Number State | TN
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