Healthcare Provider Details

I. General information

NPI: 1801554837
Provider Name (Legal Business Name): KATRINA N WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 SHALLOWFORD RD
CHATTANOOGA TN
37421-5406
US

IV. Provider business mailing address

6401 SHALLOWFORD RD
CHATTANOOGA TN
37421-5406
US

V. Phone/Fax

Practice location:
  • Phone: 423-893-6500
  • Fax:
Mailing address:
  • Phone: 423-893-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3848G
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: