Organization
SKYRIDGE CLINICAL ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARVIN KENT CHASTAIN M.D. (PRESIDENT)
(423) 479-4165
Entity
Organization
Contact information
Practice address
1060 PEERLESS CROSSING, STE 200, CLEVELAND, TN 37312-3861
(423) 479-4165
Mailing address
1060 PEERLESS CROSSING, STE 200, CLEVELAND, TN 37312-3861
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30150621
—
TN
01
—
4173087
BLUE CROSS BLUE SHIELD
TN
Enumeration date
09/11/2006
Last updated
08/19/2009
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