Individual
DR. JOHNATHAN MATTHEW MAULDIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
975 E. THIRD STREET, CHATTANOOGA, TN 37403-2147
(423) 778-7608
(423) 778-2360
Mailing address
PO BOX 11225, CHATTANOOGA, TN 37401-2225
(423) 892-5602
(423) 892-5838
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
059831
GA
207L00000X
Anesthesiology Physician
Primary
MD460888
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122775
—
AL
01
—
4266902
BLUE CROSS BLUE SHIELD TN
TN
05
—
880355416A
—
GA
01
—
NPI
TRICARE
TN
Enumeration date
03/30/2007
Last updated
10/07/2010
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