Provider Demographics
NPI:1487331203
Name:GARDENHIRE, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GARDENHIRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7104 BONNY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1003
Mailing Address - Country:US
Mailing Address - Phone:423-893-9993
Mailing Address - Fax:
Practice Address - Street 1:7104 BONNY OAKS DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1003
Practice Address - Country:US
Practice Address - Phone:423-893-9993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL0000000322923747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1518109982OtherNON-MEDICAL