Provider Demographics
NPI:1699976076
Name:EAST BRAINERD INTERNAL MEDICINE, PC
Entity type:Organization
Organization Name:EAST BRAINERD INTERNAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-899-5241
Mailing Address - Street 1:1720 GUNBARREL RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3192
Mailing Address - Country:US
Mailing Address - Phone:423-899-5241
Mailing Address - Fax:423-894-7312
Practice Address - Street 1:1720 GUNBARREL RD
Practice Address - Street 2:SUITE 110
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3192
Practice Address - Country:US
Practice Address - Phone:423-899-5241
Practice Address - Fax:423-894-7312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNCH4174OtherR.R. MEDICARE NUMBER
TN4102755OtherGROUP BCBC OF TN NUMBER
TNCH4174OtherR.R. MEDICARE NUMBER