Provider Demographics
NPI:1538420229
Name:HARTGROVE, NATHAN (DO)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:HARTGROVE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 SPRING CREEK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-3909
Mailing Address - Country:US
Mailing Address - Phone:423-893-9787
Mailing Address - Fax:423-893-9037
Practice Address - Street 1:961 SPRING CREEK RD STE 300
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412
Practice Address - Country:US
Practice Address - Phone:423-893-9787
Practice Address - Fax:423-893-9037
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN02879207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program