MEDICARE: DR. CHRISTOPHER D PRATER 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	207Q00000X	Family Medicine Physician	TN8547	TN
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	TN8547	TN
3	101YM0800X	Mental Health Counselor	TN8547	TN
4	103TM1800X	Intellectual & Developmental Disabilities Psychologist	TN8547	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	103I084762	OTHER	TN	MEDICARE PTAN
3	3370066	OTHER	TN	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	4256026	OTHER	TN	BCBS PIN

General Provider Information

NPI Number	:	1598767444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER D PRATER MD

Provider Business Mailing Address
First Line	:	105 LEE PARKWAY DR
Second Line	:	SUITE A
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-6708
Country	:	US
Telephone Number	:	423-305-1508
Fax Number	:	423-305-1514

Provider Business Practice Location Address
First Line	:	105 LEE PARKWAY DR
Second Line	:	SUITE A
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-6708
Country	:	US
Telephone Number	:	423-305-1508
Fax Number	:	423-305-1514

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	10/19/2010

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Directions to “ DR. CHRISTOPHER D PRATER MD” Practice Location

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