Organization
EASTSIDE INTERNAL MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER ALAY (OFFICE MANAGER)
(423) 648-8110
Entity
Organization
Contact information
Practice address
1720 GUNBARREL ROAD, SUITE 206, CHATTANOOGA, TN 37421
(423) 648-8110
(423) 443-4297
Mailing address
PO BOX 21090, CHATTANOOGA, TN 37424-0090
(423) 648-8110
(423) 443-4297
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
31560
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3888401
—
TN
Enumeration date
12/19/2006
Last updated
10/12/2011
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