MEDICARE: SUSAN ALEXANDRA NECAISE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		TN

General Provider Information

NPI Number	:	1780540534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN ALEXANDRA NECAISE PA-C

Provider Business Mailing Address
First Line	:	975 E 3RD ST
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37403-2173
Country	:	US
Telephone Number	:	423-778-5661
Fax Number	:

Provider Business Practice Location Address
First Line	:	979 E 3RD ST STE C520
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37403-2137
Country	:	US
Telephone Number	:	423-778-5661
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/24/2025
Last Update Date	:	12/24/2025

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