Individual
COREY MICAH CARPENTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2341 MCCALLIE AVE, SUITE 402, CHATTANOOGA, TN 37404-3239
(423) 698-3309
(423) 624-6355
Mailing address
PO BOX 3549, CHATTANOOGA, TN 37404-0549
(423) 698-3309
(423) 624-6355
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD43390
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1507379
—
TN
01
—
4184049
BLUE CROSS BLUE SHIELD OF TN
TN
01
—
P00636666
RAILROAD MEDICARE
—
Enumeration date
06/14/2007
Last updated
09/07/2011
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