Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD40365 | TN |
N | 208600000X | Surgeon | MD40365 | TN |
N | 2086S0120X | Pediatric Surgery | 054446 | GA |
Y | 2086S0120X | Pediatric Surgery | MD40365 | TN |
NPI | 1124206230 |
---|---|
Provider Name | Dr. Curtis Stokes Koontz |
First Address | Chattanooga, TN 37403-2136 |
Second Address | Chattanooga, TN 37403-2136 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2008 |
Last Update Date | 11/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1514319 | (05) | TN |
40365 | SURGERY/PEDIATRIC SURGERY (01) | TN |
4230223 | BCBS (01) | TN |
4662239 | CIGNA (01) | |
7617621 | (05) | NC |
905222216A | (05) | GA |