Basic Information
| Provider Information | |||||||||
| NPI: | 1811964554 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEMMERER | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | R. | ||||||||
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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: | 03/01/2006 | ||||||||
| 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 | 2085B0100X | 34995 | TN | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085B0100X | 049910 | GA | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085R0202X | 049910 | GA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 34995 | TN | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0202X | 34995 | TN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 049910 | GA | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 006868 | 01 | GA | BCBS OF GA | OTHER | 4073007 | 01 | TN | BCBS OF TN | OTHER | 000795561 | 05 | GA | MEDICAID | 3865400 | 05 | TN | MEDICAID | 868525 | 01 | GA | GA BCBS | OTHER | 4014295 | 01 | TN | TN BCBS | OTHER |