Provider Demographics
NPI:1316326960
Name:EWING, ERIK RANDALL (MD)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:RANDALL
Last Name:EWING
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 1:1949 GUNBARREL ROAD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421
Mailing Address - Country:US
Mailing Address - Phone:423-495-4349
Mailing Address - Fax:423-495-4934
Practice Address - Street 1:6800 HARRISON PARK DRIVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:TN
Practice Address - Zip Code:37341
Practice Address - Country:US
Practice Address - Phone:423-344-7095
Practice Address - Fax:423-344-7569
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA77473207Q00000X
GA077473207Q00000X
TN56877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine