Provider Demographics
NPI:1104892017
Name:YATES, MUNFORD RADFORD (MD)
Entity type:Individual
Prefix:DR
First Name:MUNFORD
Middle Name:RADFORD
Last Name:YATES
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 1:4976 ALPHA LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5470
Mailing Address - Country:US
Mailing Address - Phone:423-308-0280
Mailing Address - Fax:423-308-0281
Practice Address - Street 1:2200 E 3RD ST STE 200
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2745
Practice Address - Country:US
Practice Address - Phone:423-643-2500
Practice Address - Fax:423-305-7822
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34041207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN34041OtherTN LICENSE NUMBER
TN3854336Medicare ID - Type Unspecified
TN34041OtherTN LICENSE NUMBER