Basic Information
| Provider Information | |||||||||
| NPI: | 1831268960 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WORTMAN | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 494 BROOK HAVEN DR | ||||||||
| Address2: | |||||||||
| City: | HIXSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373436219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238471563 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 E 3RD ST | ||||||||
| Address2: | SUITE G100 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374032201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236431970 | ||||||||
| FaxNumber: | 4236432030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 133V00000X | 1614 | TN | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.