MEDICARE: ROBERT R SCIULLI JR. PA-C

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	363A00000X	Physician Assistant	1604	TN

General Provider Information

NPI Number	:	1033154398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT R SCIULLI JR. PA-C

Provider Business Mailing Address
First Line	:	281 N LYERLY ST STE 200
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37404-2749
Country	:	US
Telephone Number	:	423-698-0850
Fax Number	:	423-698-0511

Provider Business Practice Location Address
First Line	:	4957 SWINYAR DR STE 101
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-2205
Country	:	US
Telephone Number	:	423-362-7777
Fax Number	:

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

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	11/05/2025

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