1831382373 NPI number — DR. TRACY M DOZIER MD

Table of content: DR. TRACY M DOZIER MD (NPI 1831382373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831382373 NPI number — DR. TRACY M DOZIER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOZIER
Provider First Name:
TRACY
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROBINSON
Provider Other First Name:
TRACY
Provider Other Middle Name:
MERRILL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831382373
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11589
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37401-2589
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-778-3274
Provider Business Mailing Address Fax Number:
423-778-2255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
979 EAST THIRD STREET
Provider Second Line Business Practice Location Address:
SUITE B-601
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37403-3316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-778-8179
Provider Business Practice Location Address Fax Number:
423-778-8180
Provider Enumeration Date:
08/18/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  46023 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)