Healthcare Provider Details

I. General information

NPI: 1851474563
Provider Name (Legal Business Name): ASSOCIATES IN ORAL AND MAXILLOFACIAL SURGERY, P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6015 SHALLOWFORD ROAD
CHATTANOOGA TN
37421-1688
US

IV. Provider business mailing address

6015 SHALLOWFORD ROAD
CHATTANOOGA TN
37421-1688
US

V. Phone/Fax

Practice location:
  • Phone: 423-893-3333
  • Fax: 423-893-6747
Mailing address:
  • Phone: 423-893-3333
  • Fax: 423-893-6747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number StateTN

VIII. Authorized Official

Name: DR. WAYNE E TIPPS
Title or Position: ADMINISTRATOR
Credential:
Phone: 423-893-3333