Healthcare Provider Details

I. General information

NPI: 1033381595
Provider Name (Legal Business Name): BEACON HEALTH ALLIANCE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 MORRISON SPRINGS RD SUITE 201
CHATTANOOGA TN
37415-3402
US

IV. Provider business mailing address

PO BOX 6159
CHATTANOOGA TN
37401-6159
US

V. Phone/Fax

Practice location:
  • Phone: 423-877-4556
  • Fax: 423-877-9218
Mailing address:
  • Phone: 423-495-4939
  • Fax: 423-495-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHEILA MANLEY
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 423-495-4806