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General NPI Number Information
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NPI Number | 1891248092
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Entity Type | Organization
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Legal Business Name | GALEN MEDICAL GROUP PC
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Dates
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Enumeration Date | 07/25/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2200 E 3RD ST STE 200
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City | CHATTANOOGA
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State | TN
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Zip | 37404-2745
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Country | US
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Telephone | 423-643-2500
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Fax | 423-305-7822
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Provider Business Mailing Address
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Address Line | 2200 E 3RD ST STE 200
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City | CHATTANOOGA
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State | TN
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Zip | 37404-2745
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Country | US
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Telephone | 423-643-2500
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Fax | 423-305-7822
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. CHARLES J. LATHRAM
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Credential |
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Telephone | 423-308-0521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | 5807
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License Number State | TN
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