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General NPI Number Information
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NPI Number | 1720416878
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Entity Type | Organization
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Legal Business Name | SE TN EMERGENCY PHYSICIANS PLLC
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 03/29/2021
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Provider Practice Location Address
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Address Line | 2333 MCCALLIE AVE
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City | CHATTANOOGA
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State | TN
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Zip | 37404-3258
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Country | US
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Telephone | 423-698-8061
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Fax |
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Provider Business Mailing Address
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Address Line | 5565 CENTERVIEW DR STE 107
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City | RALEIGH
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State | NC
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Zip | 27606-3563
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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 | OFFICER
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Name | KATHLEEN KONDAS
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Credential |
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Telephone | 973-251-1132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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