Healthcare Provider Details

I. General information

NPI: 1154325934
Provider Name (Legal Business Name): SYNTHIA L BEELER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7446 SHALLOWFORD RD STE 200
CHATTANOOGA TN
37421-8815
US

IV. Provider business mailing address

PO BOX 11543
CHATTANOOGA TN
37401-2543
US

V. Phone/Fax

Practice location:
  • Phone: 423-643-3772
  • Fax: 423-643-3773
Mailing address:
  • Phone: 423-877-2312
  • Fax: 423-877-5855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31124
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: