Basic Information
| Provider Information | |||||||||
| NPI: | 1437170180 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUNTZINGER | ||||||||
| FirstName: | GRANT | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1604 GUNBARREL RD | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374213125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236482395 | ||||||||
| FaxNumber: | 4236487542 | ||||||||
| Practice Location | |||||||||
| Address1: | 1604 GUNBARREL RD | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374213125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238937226 | ||||||||
| FaxNumber: | 4238937398 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 02/22/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 022420 | GA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MD11568 | TN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 4073000 | 01 | TN | BCBS OF TN | OTHER | 44770 | 01 | TN | BCBS OF TN | OTHER | 151364 | 01 | GA | BCBS OF GA | OTHER | 3805918 | 05 | TN | MEDICAID | 000248476 | 05 | GA | MEDICAID | 511425 | 01 | GA | BCBS OF GA | OTHER |