Healthcare Provider Details

I. General information

NPI: 1770770679
Provider Name (Legal Business Name): CHATTANOOGA WOMEN'S SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 OLD LAFAYETTE RD
FORT OGLETHORPE GA
30742-3510
US

IV. Provider business mailing address

2009 OLD LAFAYETTE RD
FT OGLETHORPE GA
30742-3510
US

V. Phone/Fax

Practice location:
  • Phone: 706-861-5950
  • Fax: 706-858-0475
Mailing address:
  • Phone: 706-861-5950
  • Fax: 706-858-0475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DONNA W BLAES
Title or Position: OFFICE MANAGER
Credential:
Phone: 706-861-5950