MEDICARE: DR. COLLIN G CHERRY 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	207R00000X	Internal Medicine Physician	17136	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	93335	OTHER		BCBSTN

General Provider Information

NPI Number	:	1659375491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLLIN G CHERRY MD

Provider Business Mailing Address
First Line	:	725 GLENWOOD DR
Second Line	:	SUITE 480
City	:	CHATTANOOGA
State	:	TN
Zip	:	37404-1163
Country	:	US
Telephone Number	:	423-756-5779
Fax Number	:	423-242-4552

Provider Business Practice Location Address
First Line	:	725 GLENWOOD DR
Second Line	:	SUITE 480
City	:	CHATTANOOGA
State	:	TN
Zip	:	37404-1163
Country	:	US
Telephone Number	:	423-756-5779
Fax Number	:	423-242-4552

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	01/15/2009

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