Provider Demographics
NPI:1679869101
Name:COMBS, ANDREW GLENN (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:GLENN
Last Name:COMBS
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 1:921 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2102
Mailing Address - Country:US
Mailing Address - Phone:423-209-8239
Mailing Address - Fax:423-209-8241
Practice Address - Street 1:921 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2102
Practice Address - Country:US
Practice Address - Phone:423-209-8239
Practice Address - Fax:423-209-8241
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47268208000000X
GA069569208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000211956AMedicaid
GA000211956CMedicaid
TN1524986Medicaid
GA111907Medicare Oscar/Certification
GA111815Medicare Oscar/Certification
GA000211956CMedicaid