Individual
RYAN JUSTICE MCCORMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2525 DESALES AVE, CHATTANOOGA, TN 37404-1161
(423) 495-2525
Mailing address
1808 WILLIAMS ST, CHATTANOOGA, TN 37408-1726
(423) 605-3135
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0000214047
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
30840
TN
Other
Enumeration date
02/19/2021
Last updated
12/16/2021
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