Provider Demographics
NPI:1124206230
Name:KOONTZ, CURTIS STOKES (MD)
Entity type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:STOKES
Last Name:KOONTZ
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 1:979 E 3RD ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2136
Mailing Address - Country:US
Mailing Address - Phone:423-757-0747
Mailing Address - Fax:423-757-0770
Practice Address - Street 1:979 E 3RD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2136
Practice Address - Country:US
Practice Address - Phone:423-267-0466
Practice Address - Fax:423-757-0747
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0544462086S0120X
TNMD403652086S0120X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4230223OtherBCBS
NC7617621Medicaid
4662239OtherCIGNA
TN1514319Medicaid
TN40365OtherSURGERY/PEDIATRIC SURGERY
GA905222216AMedicaid
103I021666Medicare PIN