Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 3106 | TN |
NPI | 1144211673 |
---|---|
Provider Name | Dr. Stokely E. Doster JR. |
First Address | Chattanooga, TN 37402-5014 |
Second Address | Chattanooga, TN 37402-5014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2005 |
Last Update Date | 08/07/2007 |