NPIMap

Organization Active NPI

Personal Medicine LLC

  • Addiction Medicine (Family Medicine) Physician
  • Chattanooga, TN
National Provider Identifier
1780975540
Registry record updated Jun 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X
Legal business name
PERSONAL MEDICINE LLC
Practice address
207 Spears Ave
Chattanooga, TN 37405
Phone
(423) 531-4265
Fax
(423) 531-4267
NPI assigned
Apr 28, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2018

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

Authorized official

Name
John Brendle Standridge, MD
Title
Owner
Phone
(423) 531-4265

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Family Medicine) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207QA0401X Primary

Addresses

Primary practice location

207 Spears Ave
Chattanooga, TN 37405

Mailing address

6838 Buck Trail Dr
Harrison, TN 37341-4912
Phone (423) 531-4265

Other identifiers 1

IdentifierTypeStateIssuer
1523731MedicaidTN

National Provider Directory

National Provider Directory

Locations

2115 Stein Dr
Ste 304
Chattanooga, TN 37421
Phone (423) 531-4265

Practitioners & affiliated clinicians

Practitioners 5

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": "1303948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529712000000",
    "number": "1780975540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6838 BUCK TRAIL DR",
            "city": "HARRISON",
            "state": "TN",
            "postal_code": "373414912",
            "telephone_number": "423-531-4265",
            "fax_number": "423-531-4267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 SPEARS AVE",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "37405",
            "telephone_number": "423-531-4265",
            "fax_number": "423-531-4267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERSONAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-28",
        "last_updated": "2018-06-23",
        "status": "A",
        "authorized_official_last_name": "STANDRIDGE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "BRENDLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-531-4265",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1523731",
            "state": "TN"
        }
    ],
    "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 Jun 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.