MEDICARE: KATHERINE S MCCLELLAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician	61985	TN
2	207QA0505X	Adult Medicine Physician	38347	AL
3	207QA0505X	Adult Medicine Physician	86815	GA

General Provider Information

NPI Number	:	1023544871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE S MCCLELLAN MD

Provider Business Mailing Address
First Line	:	1949 GUNBARREL RD STE 206
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-7133
Country	:	US
Telephone Number	:	423-495-4345
Fax Number	:	423-495-4934

Provider Business Practice Location Address
First Line	:	4700 BATTLEFIELD PKWY STE 200
Second Line	:
City	:	RINGGOLD
State	:	GA
Zip	:	30736-5168
Country	:	US
Telephone Number	:	706-861-4990
Fax Number	:	706-861-9405

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	11/10/2020

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