Basic Information
| Provider Information | |||||||||
| NPI: | 1982946091 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OSSMAN | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | AARON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 975 E 3RD ST | ||||||||
| Address2: | ATTN: PROVIDER ENROLLMENT | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374032147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237788909 | ||||||||
| FaxNumber: | 4237788910 | ||||||||
| Practice Location | |||||||||
| Address1: | 1751 GUNBARREL RD | ||||||||
| Address2: | SUITE #201 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374217177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237788909 | ||||||||
| FaxNumber: | 4237788910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2013 | ||||||||
| LastUpdateDate: | 09/14/2016 | ||||||||
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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 | 207Q00000X | 54951 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.