Basic Information
Provider Information
NPI: 1609174986
EntityType: 2
ReplacementNPI:  
OrganizationName: CHATTANOOGA HAMILTON COUNTY HOSPITAL AUTHORITY
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: UT-ERLANGER ENDOCRINOLOGY
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 11589
Address2:  
City: CHATTANOOGA
State: TN
PostalCode: 374012589
CountryCode: US
TelephoneNumber: 4237783274
FaxNumber: 4237782255
Practice Location
Address1: 325 MARKET ST
Address2: SUITE 200
City: CHATTANOOGA
State: TN
PostalCode: 374021226
CountryCode: US
TelephoneNumber: 4237785560
FaxNumber: 4237785561
Other Information
ProviderEnumerationDate: 03/10/2011
LastUpdateDate: 03/10/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: SWAFFORD
AuthorizedOfficialFirstName: CATHY
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: DIRECTOR PHYSICIAN SERVICES
AuthorizedOfficialTelephone: 4237784044
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RE0101X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism

No ID Information.


Home