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General NPI Number Information
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NPI Number | 1780975540
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Entity Type | Organization
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Legal Business Name | PERSONAL MEDICINE LLC
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Dates
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Enumeration Date | 04/28/2011
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Last Update Date | 06/23/2018
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Provider Practice Location Address
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Address Line | 207 SPEARS AVE
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City | CHATTANOOGA
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State | TN
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Zip | 37405
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Country | US
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Telephone | 423-531-4265
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Fax | 423-531-4267
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Provider Business Mailing Address
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Address Line | 6838 BUCK TRAIL DR
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City | HARRISON
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State | TN
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Zip | 37341-4912
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Country | US
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Telephone | 423-531-4265
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Fax | 423-531-4267
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Authorized Official
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Title or Position | OWNER
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Name | JOHN BRENDLE STANDRIDGE
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Credential | MD
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Telephone | 423-531-4265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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