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General NPI Number Information
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NPI Number | 1790991024
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Entity Type | Organization
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Legal Business Name | BRAINERD MEDICAL ASSOCIATES PC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4929 BRAINERD RD
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City | CHATTANOOGA
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State | TN
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Zip | 37411-3902
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Country | US
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Telephone | 423-894-5003
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8768
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City | CHATTANOOGA
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State | TN
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Zip | 37414-0768
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Country | US
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Telephone | 423-894-5003
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHANEY MASON
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Credential | D.C.
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Telephone | 423-894-5003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT0000005385
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License Number State | TN
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