NPIMap

Organization Active NPI

Four Bridges Dermatology and Cosmetics PLLC

  • Dermatology Physician
  • Chattanooga, TN
National Provider Identifier
1043971575
Registry record updated Mar 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
FOUR BRIDGES DERMATOLOGY AND COSMETICS PLLC
Practice address
1247 Riverfront Pkwy
Chattanooga, TN 37402-2108
Phone
(423) 521-4232
Fax
(423) 521-4235
NPI assigned
Jan 6, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Laura Cleary, MDNPI 1669891883
Title
Partner
Phone
(423) 521-4232

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary
Clinic/Center 261Q00000X

Addresses

Primary practice location

1247 Riverfront Pkwy
Chattanooga, TN 37402-2108

Mailing address

1247 Riverfront Pkwy
Chattanooga, TN 37402-2108

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220405000828 TN Part B Supplier - Clinic/Group Practice 0345636189 Receives reassigned benefits from 6 practitioners
Practice locations: Chattanooga, TN

National Provider Directory

National Provider Directory

Locations

1247 Riverfront Pkwy
Ste 205
Chattanooga, TN 37402
Phone (423) 521-4232

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1641427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648684800000",
    "number": "1043971575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1247 RIVERFRONT PKWY",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374022108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1247 RIVERFRONT PKWY",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374022108",
            "telephone_number": "423-521-4232",
            "fax_number": "423-521-4235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUR BRIDGES DERMATOLOGY AND COSMETICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-06",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A",
        "authorized_official_last_name": "CLEARY",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "423-521-4232",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chattanooga, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.