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General NPI Number Information
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NPI Number | 1871647800
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Entity Type | Organization
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Legal Business Name | SCENIC CITY RHEUMATOLOGY, PLLC
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 06/09/2023
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Provider Practice Location Address
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Address Line | 6145 SHALLOWFORD RD STE 102
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City | CHATTANOOGA
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State | TN
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Zip | 37421-7808
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Country | US
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Telephone | 423-893-6890
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Fax | 423-648-1115
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Provider Business Mailing Address
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Address Line | 6145 SHALLOWFORD RD STE 102
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City | CHATTANOOGA
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State | TN
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Zip | 37421-7808
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Country | US
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Telephone | 423-893-6890
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Fax | 423-648-1115
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD W BRACKETT
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Credential | MD
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Telephone | 423-893-6890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 16562
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License Number State | TN
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