MEDICARE: MS. REAGIN FARLEY RHODES 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
2	363A00000X	Physician Assistant	3312	TN

General Provider Information

NPI Number	:	1215449616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REAGIN FARLEY RHODES PA-C

Provider Business Mailing Address
First Line	:	900 MOUNTAIN CREEK RD APT B25
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37405-4506
Country	:	US
Telephone Number	:	205-807-7553
Fax Number	:

Provider Business Practice Location Address
First Line	:	3917 GEORGETOWN RD NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-1806
Country	:	US
Telephone Number	:	423-813-3830
Fax Number	:

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

Provider Enumeration Date	:	10/26/2017
Last Update Date	:	12/26/2024

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