Provider Demographics
NPI:1871525477
Name:EDDLEMON, EUGENE D (MD)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:D
Last Name:EDDLEMON
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 1:979 E 3RD STREET
Mailing Address - Street 2:STE. 300
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2187
Mailing Address - Country:US
Mailing Address - Phone:423-267-0466
Mailing Address - Fax:423-778-5177
Practice Address - Street 1:2253 CHAMBLISS AVE.
Practice Address - Street 2:STE. 401
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311
Practice Address - Country:US
Practice Address - Phone:423-267-0466
Practice Address - Fax:423-778-5177
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68376208600000X, 2086S0129X
TNMD673912086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ090231Medicaid
CAG68376OtherBLUE CROSS/SHIELD, ETC.
CA00G683761Medicaid
CA94-3365249OtherPRIVATE PAYERS
CAG68376OtherBLUE CROSS/SHIELD, ETC.
CA00G683760Medicare PIN