Healthcare Provider Details

I. General information

NPI: 1790370633
Provider Name (Legal Business Name): THE CHATTANOOGA SPINE AND WELLNESS INSTITUTE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6250 ABBOTTS BRIDGE RD STE 100
DULUTH GA
30097-1713
US

IV. Provider business mailing address

6250 ABBOTTS BRIDGE RD STE 100
DULUTH GA
30097-1713
US

V. Phone/Fax

Practice location:
  • Phone: 423-296-2604
  • Fax: 423-296-2607
Mailing address:
  • Phone: 423-296-2604
  • Fax: 423-296-2607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JESSICA NOEL TAYLOR
Title or Position: CLINIC DIRECTOR
Credential:
Phone: 423-296-2604