Healthcare Provider Details

I. General information

NPI: 1073436861
Provider Name (Legal Business Name): MISS DAWNN AYESHA VANCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DAWNN AYESHA VANCE STUD. DR.

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 ROSSVILLE BLVD
CHATTANOOGA TN
37407-2546
US

IV. Provider business mailing address

1102 WHEELER AVE
CHATTANOOGA TN
37406-3260
US

V. Phone/Fax

Practice location:
  • Phone: 423-402-0149
  • Fax:
Mailing address:
  • Phone: 423-402-0149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number85024
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: