Basic Information
Provider Information
NPI: 1740208750
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STEVENS
FirstName: CATHY
MiddleName: A.
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 11503
Address2:  
City: CHATTANOOGA
State: TN
PostalCode: 374012503
CountryCode: US
TelephoneNumber: 4237785445
FaxNumber: 4237783157
Practice Location
Address1: 910 BLACKFORD ST
Address2:  
City: CHATTANOOGA
State: TN
PostalCode: 374031405
CountryCode: US
TelephoneNumber: 4237785445
FaxNumber: 4237783157
Other Information
ProviderEnumerationDate: 07/17/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207SG0201X15446TNY Allopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)

No ID Information.


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