Healthcare Provider Details

I. General information

NPI: 1205484706
Provider Name (Legal Business Name): SAMARA BATES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 01/13/2025
Certification Date:
Deactivation Date: 11/03/2023
Reactivation Date: 01/13/2025

III. Provider practice location address

6110 SHALLOWFORD RD
CHATTANOOGA TN
37421-1894
US

IV. Provider business mailing address

6110 SHALLOWFORD RD
CHATTANOOGA TN
37421-1894
US

V. Phone/Fax

Practice location:
  • Phone: 901-509-5406
  • Fax:
Mailing address:
  • Phone: 901-509-5406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: