Individual
JEREMY B. WADDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C.
Contact information
Practice address
979 EAST 3RD STREET, SUITE 300, CHATTANOOGA, TN 37403-2187
(423) 267-0466
(423) 757-0866
Mailing address
979 EAST 3RD STREET, SUITE 300, CHATTANOOGA, TN 37403-2187
(423) 267-0466
(423) 757-0866
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1078
KY
363AM0700X
Medical Physician Assistant
PA1078
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37903705
MEDICIAD LAB GRP
KY
01
—
4000501
MEDICARE LAB GRP
KY
05
—
7100021560
—
KY
01
—
P00469363
RR MEDICARE PIN
KY
Enumeration date
10/16/2007
Last updated
10/15/2010
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