Basic Information
| Provider Information | |||||||||
| NPI: | 1316326960 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EWING | ||||||||
| FirstName: | ERIK | ||||||||
| MiddleName: | RANDALL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1949 GUNBARREL ROAD | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234954349 | ||||||||
| FaxNumber: | 4234954934 | ||||||||
| Practice Location | |||||||||
| Address1: | 6800 HARRISON PARK DRIVE | ||||||||
| Address2: | |||||||||
| City: | HARRISON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4233447095 | ||||||||
| FaxNumber: | 4233447569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2015 | ||||||||
| LastUpdateDate: | 06/05/2018 | ||||||||
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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 | 207Q00000X | 77473 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 077473 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 56877 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.