Basic Information
| Provider Information | |||||||||
| NPI: | 1275871519 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPOON | ||||||||
| FirstName: | GARRICK | ||||||||
| MiddleName: | BJORN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 605 GLENWOOD DR | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374041108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234952635 | ||||||||
| FaxNumber: | 4234952638 | ||||||||
| Practice Location | |||||||||
| Address1: | 605 GLENWOOD DR | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374041108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234952635 | ||||||||
| FaxNumber: | 4234952638 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2013 | ||||||||
| LastUpdateDate: | 01/22/2013 | ||||||||
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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 | 363AM0700X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.