Provider Demographics
NPI:1528048634
Name:KERLEY, STEPHEN L (DO)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:L
Last Name:KERLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7155 LEE HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-0801
Mailing Address - Country:US
Mailing Address - Phone:423-551-3560
Mailing Address - Fax:423-551-3561
Practice Address - Street 1:7155 LEE HWY STE 200
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421
Practice Address - Country:US
Practice Address - Phone:423-551-3560
Practice Address - Fax:423-551-3561
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1403207V00000X
TN01403207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H48111Medicare UPIN
3306868Medicare PIN