Provider Demographics
NPI:1881484632
Name:AMERICAN ID GROUP LLC
Entity type:Organization
Organization Name:AMERICAN ID GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUNENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-347-1517
Mailing Address - Street 1:2339 MCCALLIE AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3209
Mailing Address - Country:US
Mailing Address - Phone:423-654-7000
Mailing Address - Fax:423-654-7001
Practice Address - Street 1:2339 MCCALLIE AVE STE 401
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3209
Practice Address - Country:US
Practice Address - Phone:423-654-7000
Practice Address - Fax:423-654-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-07
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty