Basic Information
Provider Information
NPI: 1669899563
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DYER
FirstName: ALFORD
MiddleName: LEON
NamePrefix: DR.
NameSuffix: III
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1949 GUNBARREL ROAD
Address2: SUITE 230
City: CHATTANOOGA
State: TN
PostalCode: 37421
CountryCode: US
TelephoneNumber: 4234954349
FaxNumber: 4234954934
Practice Location
Address1: 4700 BATTLEFIELD PARKWAY, SUITE 230
Address2: CHI MEMORIAL PEDIATRIC DIAGNOSTIC ASSOCIATES
City: RINGGOLD
State: GA
PostalCode: 30736
CountryCode: US
TelephoneNumber: 4236982229
FaxNumber: 4236220619
Other Information
ProviderEnumerationDate: 03/28/2014
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X078618GAY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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