Provider Demographics
NPI:1316052624
Name:KERRY D. FRIESEN, M.D. PC
Entity type:Organization
Organization Name:KERRY D. FRIESEN, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:FRIESEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-553-9995
Mailing Address - Street 1:7405 SHALLOWFORD RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2661
Mailing Address - Country:US
Mailing Address - Phone:423-553-9995
Mailing Address - Fax:423-553-9966
Practice Address - Street 1:7405 SHALLOWFORD RD
Practice Address - Street 2:SUITE 270
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2661
Practice Address - Country:US
Practice Address - Phone:423-553-9995
Practice Address - Fax:423-553-9966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27073207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3375891Medicare ID - Type Unspecified
TNF89044Medicare UPIN