MEDICARE: DR. ERNEST RACKLEY IVEY M.D.

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	2084F0202X	Forensic Psychiatry Physician	44317-020	WI
2	2084P0005X	Neurodevelopmental Disabilities Physician	44317-020	WI
3	2084P0800X	Psychiatry Physician	44317-020	WI
4	2084P0804X	Child & Adolescent Psychiatry Physician	44317-020	WI
5	2084P0805X	Geriatric Psychiatry Physician	0101232074	VA
6	209800000X	Legal Medicine (M.D./D.O.) Physician	44317-020	WI
7	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	44317-020	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19248	OTHER	SC	MEDICAL LICENSE
2	67772	OTHER	GA	MEDICAL LICENSE
3	036-103584	OTHER	IL	MEDICAL LICENSE
4	44317-20	OTHER	WI	MEDICAL LICENSE
5	0101232074	OTHER	VA	MEDICAL LICENSE
6	11027179	OTHER		CAQH
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568459212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERNEST RACKLEY IVEY M.D.

Provider Business Mailing Address
First Line	:	1300 SOUTH DRIVE
Second Line	:
City	:	WINNEBAGO
State	:	WI
Zip	:	54985-0009
Country	:	US
Telephone Number	:	920-235-4910
Fax Number	:	920-237-2800

Provider Business Practice Location Address
First Line	:	4346 LAKESHORE LN UNIT 304
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37415-7169
Country	:	US
Telephone Number	:	608-354-3947
Fax Number	:

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	12/21/2022

Similar Medicare Providers

1528063211 — DR. JOHN H. CHROSTOWSKI MD
Practice Location Address:

2158 NORTHGATE PARK LN , SUITE 100
CHATTANOOGA, TN
37415-6911

Practice Phone: 423-803-2460
Practice Fax: 423-803-2461

1275539975 — MR. STEVEN M THOMAS MD
Practice Location Address:

632 MORRISON SPRINGS RD , STE 301
CHATTANOOGA, TN
37415-3402

Practice Phone: 423-778-2020
Practice Fax:

1003815580 — DR. THOMAS M REYNOLDS M.D.
Practice Location Address:

2158 NORTHGATE PARK LN , SUITE 302
CHATTANOOGA, TN
37415-6957

Practice Phone: 423-870-4900
Practice Fax: 423-870-5889

1861486441 — MUKTA PANDA MD
Practice Location Address:

3905 HIXSON PIKE STE 103
CHATTANOOGA, TN
37415-3569

Practice Phone: 423-756-1506
Practice Fax: 423-756-1909

1013905728 — JANE S CATTERTON M.D.
Practice Location Address:

632 MORRISON SPRINGS RD , SUITE 300
CHATTANOOGA, TN
37415-3416

Practice Phone: 423-877-4524
Practice Fax: 423-875-5860

1831187541 — RONALD L MOLLOY M.D.
Practice Location Address:

632 MORRISON SPRINGS RD , SUITE 300
CHATTANOOGA, TN
37415-3416

Practice Phone: 423-877-4524
Practice Fax: 423-875-5860

Directions to “ DR. ERNEST RACKLEY IVEY M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.