MEDICARE: LANDMARK MEDICAL

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1801276316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANDMARK MEDICAL

Provider Business Mailing Address
First Line	:	103 JORDAN DR
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-6715
Country	:	US
Telephone Number	:	423-805-5113
Fax Number	:	423-805-5139

Provider Business Practice Location Address
First Line	:	103 JORDAN DR
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-6715
Country	:	US
Telephone Number	:	423-805-5113
Fax Number	:	423-805-5139

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRISTIAN STOVALL
Credential	:
Telephone Number	:	901-233-9201

Provider Enumeration Date	:	06/01/2015
Last Update Date	:	11/06/2015

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Directions to “LANDMARK MEDICAL ” Practice Location

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