Basic Information
| Provider Information | |||||||||
| NPI: | 1720179567 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | J WALTER SLEDGE MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11426 | ||||||||
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| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238772312 | ||||||||
| FaxNumber: | 4238775855 | ||||||||
| Practice Location | |||||||||
| Address1: | 2339 MCCALLIE AVENUE | ||||||||
| Address2: | PLAZA II SUITE 204 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236296995 | ||||||||
| FaxNumber: | 4236296641 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 07/10/2007 | ||||||||
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| AuthorizedOfficialLastName: | ANDREWS | ||||||||
| AuthorizedOfficialFirstName: | DURIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING OFFICE OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4238772312 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 24377 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.