1619156908 NPI number — JOSEPH A. MOTTO, MD

Table of content: (NPI 1619156908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619156908 NPI number — JOSEPH A. MOTTO, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSEPH A. MOTTO, MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619156908
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 23503
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:
37422-3503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-842-5260
Provider Business Mailing Address Fax Number:
423-899-5632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4355 HIGHWAY 58
Provider Second Line Business Practice Location Address:
SUITE 107A
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37416-2939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-842-5260
Provider Business Practice Location Address Fax Number:
423-899-5632
Provider Enumeration Date:
11/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DEVLIN
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNT MANAGER
Authorized Official Telephone Number:
423-443-3524

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  MD0000014144 , 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)

  • Identifier: 529928040 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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