Provider Demographics
NPI:1427092949
Name:SPARKS, NORMA J (PA)
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:J
Last Name:SPARKS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6170 SHALLOWFORD RD
Mailing Address - Street 2:101
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1892
Mailing Address - Country:US
Mailing Address - Phone:423-648-4500
Mailing Address - Fax:423-855-7563
Practice Address - Street 1:625 E 12TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH PITTSBURG
Practice Address - State:TN
Practice Address - Zip Code:37380-1630
Practice Address - Country:US
Practice Address - Phone:423-648-4460
Practice Address - Fax:423-648-4461
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNPA0000000073363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P35904Medicare UPIN
3669334Medicare ID - Type Unspecified
TN1016710001Medicare NSC