Healthcare Provider Details

I. General information

NPI: 1275447369
Provider Name (Legal Business Name): TWO DOC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 CORPORATE DR
DALTON GA
30721-4900
US

IV. Provider business mailing address

1110 MARKET ST STE 502
CHATTANOOGA TN
37402-3310
US

V. Phone/Fax

Practice location:
  • Phone: 423-602-9530
  • Fax:
Mailing address:
  • Phone: 423-602-9230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHANA LANEA FORTENBERRY
Title or Position: ACCOUNT MANAGER/IMPLEMENTATION
Credential: CMA (AAMA)
Phone: 423-602-9530