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NPI Code Detail

MEDICARE: OTIS BRANDON FORRESTER FNP-C

MEDICARE: OTIS BRANDON FORRESTER FNP-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
12083A0300XAddiction Medicine (Preventive Medicine) Physician29396TN
2363LF0000XFamily Nurse Practitioner29396TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447362736
Entity Type Code : Individual
Provider Name (Legal Business Name) : OTIS BRANDON FORRESTER FNP-C
Provider Business Mailing Address
First Line : 2550 EXECUTIVE PARK DRIVE NE
Second Line :
City : CLEVELAND
State : TN
Zip : 37311
Country : US
Telephone Number : 423-339-9581
Fax Number : 423-472-0494
Provider Business Practice Location Address
First Line : 6141 SHALLOWFORD RD STE 100
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-1663
Country : US
Telephone Number : 423-498-2000
Fax Number : 423-498-2001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 02/23/2026

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1770589137 — DR. DONALD LYNN HAMBY M.D.
Practice Location Address:
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Practice Fax: 423-498-2001

Directions to “ OTIS BRANDON FORRESTER FNP-C” Practice Location

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