Provider Demographics
NPI:1366404535
Name:POLLOCK, PHILIP G (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:G
Last Name:POLLOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3637
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404
Mailing Address - Country:US
Mailing Address - Phone:423-629-7688
Mailing Address - Fax:423-495-6175
Practice Address - Street 1:2525 DESALES AVE
Practice Address - Street 2:PATHOLOGY LABORATORY
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1161
Practice Address - Country:US
Practice Address - Phone:423-495-8703
Practice Address - Fax:423-495-6175
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD10935207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN33850AMedicaid
F33930Medicare UPIN
TN3041449Medicare PIN