Individual
DR. ERNEST RACKLEY IVEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4346 LAKESHORE LN UNIT 304, CHATTANOOGA, TN 37415-7169
(608) 354-3947
Mailing address
1300 SOUTH DRIVE, WINNEBAGO, WI 54985-0009
(920) 235-4910
(920) 237-2800
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
44317-020
WI
2084F0202X
Forensic Psychiatry Physician
44317-020
WI
2084P0005X
Neurodevelopmental Disabilities Physician
44317-020
WI
2084P0800X
Psychiatry Physician
44317-020
WI
2084P0804X
Child & Adolescent Psychiatry Physician
44317-020
WI
2084P0805X
Geriatric Psychiatry Physician
0101232074
VA
209800000X
Legal Medicine (M.D./D.O.) Physician
44317-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101232074
MEDICAL LICENSE
VA
01
—
036-103584
MEDICAL LICENSE
IL
01
—
11027179
CAQH
—
01
—
19248
MEDICAL LICENSE
SC
05
—
3428920
—
WI
01
—
44317-20
MEDICAL LICENSE
WI
01
—
67772
MEDICAL LICENSE
GA
Enumeration date
09/27/2005
Last updated
12/21/2022
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