Basic Information
| Provider Information | |||||||||
| NPI: | 1760649800 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOONE | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | CHERIE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SCHAEFER | ||||||||
| OtherFirstName: | AMANDA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 975 E. THIRD STREET | ||||||||
| Address2: | ATTN: PROVIDER ENROLLMENT | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374032147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8444391729 | ||||||||
| FaxNumber: | 4237782108 | ||||||||
| Practice Location | |||||||||
| Address1: | 975 E. THIRD STREET | ||||||||
| Address2: | ATTN: PROVIDER ENROLLMENT | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374032147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8444391729 | ||||||||
| FaxNumber: | 4237782108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2008 | ||||||||
| LastUpdateDate: | 11/14/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2015025548 | MO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 54490-20 | WI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | TL3131 | WY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 53360 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | 53360 | TN | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.