Healthcare Provider Details

I. General information

NPI: 1699796169
Provider Name (Legal Business Name): OB-GYN CENTRE OF EXCELLENCE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 09/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2341 MCCALLIE AVE STE 302 PARKRIDGE PLAZA III
CHATTANOOGA TN
37404-3237
US

IV. Provider business mailing address

2341 MCCALLIE AVE, SUITE 302 PARKRIDGE PLAZA III
CHATTANOOGA TN
37404-3237
US

V. Phone/Fax

Practice location:
  • Phone: 423-629-9743
  • Fax: 423-629-9744
Mailing address:
  • Phone: 423-629-9743
  • Fax: 423-629-9744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MISTY A HICKMAN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 423-629-9743