Waddell, Jeremy B.

Waddell, Jeremy B. is an individual health care provider with primary practice located at 979 East 3Rd Street Suite 300, Chattanooga TN 37403-2187. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Medical. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Waddell, Jeremy B. can be contacted via phone (423) 267-0466.

Contact Information

Primary practice address
979 East 3Rd Street Suite 300 Chattanooga TN 37403-2187
Phone: (423) 267-0466
Fax: (423) 757-0866
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA1078 Kentucky
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA1078 Kentucky

Profile Details

NPI number 1649469552
LBN Legal business name Waddell, Jeremy B.
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 16th, 2007
Last updated Oct 15th, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649469552 NPPES
Kentucky Other P00469363 RR MEDICARE PIN
Kentucky Other 4000501 RR MEDICARE PIN
Kentucky MEDICAID 7100021560 RR MEDICARE PIN
Kentucky Other 37903705 RR MEDICARE PIN

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