Provider Demographics
NPI:1730399973
Name:CARLTON M. VOLLBERG, D.O.P.C
Entity type:Organization
Organization Name:CARLTON M. VOLLBERG, D.O.P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLTON
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:VOLLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:423-296-0382
Mailing Address - Street 1:1608 GUNBARREL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7197
Mailing Address - Country:US
Mailing Address - Phone:423-293-0382
Mailing Address - Fax:423-296-0383
Practice Address - Street 1:1608 GUNBARREL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7197
Practice Address - Country:US
Practice Address - Phone:423-296-0382
Practice Address - Fax:423-296-0383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3735013Medicare ID - Type Unspecified
TNF66407Medicare UPIN