Basic Information
| Provider Information | |||||||||
| NPI: | 1669703849 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OBSTETRICS & GYNECOLOGY OF HIXSON, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11026 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374012026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237029240 | ||||||||
| FaxNumber: | 4237029245 | ||||||||
| Practice Location | |||||||||
| Address1: | 2051 HAMILL RD | ||||||||
| Address2: | SUITE 211 | ||||||||
| City: | HIXSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373436614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237029240 | ||||||||
| FaxNumber: | 4237029245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2010 | ||||||||
| LastUpdateDate: | 01/27/2010 | ||||||||
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| AuthorizedOfficialLastName: | SHUCK | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4237029240 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.