Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 11459 | TN |
Y | 213EG0000X | General Practice | 11459 | TN |
NPI | 1003407461 |
---|---|
Provider Name | Carlton Baskin |
First Address | Hixson, TN 37343-5450 |
Second Address | Chattanooga, TN 37411-3847 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2021 |
Last Update Date | 28/01/2021 |