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General NPI Number Information
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NPI Number | 1831268960
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Entity Type | Individual
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Provider Name | PATRICK ALLEN WORTMAN RD
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Gender | Male
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1100 E 3RD ST SUITE G100
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City | CHATTANOOGA
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State | TN
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Zip | 37403-2201
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Country | US
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Telephone | 423-643-1970
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Fax | 423-643-2030
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Provider Business Mailing Address
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Address Line | 494 BROOK HAVEN DR
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City | HIXSON
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State | TN
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Zip | 37343-6219
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Country | US
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Telephone | 423-847-1563
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Fax |
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 1614
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License Number State | TN
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