Individual
DR. GLENN A. BEASLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2158 NORTHGATE PARK LN, SUITE 104, CHATTANOOGA, TN 37415-6957
(423) 870-2030
(423) 875-6405
Mailing address
2158 NORTHGATE PARK LN, SUITE 104, CHATTANOOGA, TN 37415-6957
(423) 870-2030
(423) 875-6405
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
MD0000020673
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3053865
—
TN
Enumeration date
03/13/2007
Last updated
03/13/2008
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