Healthcare Provider Details

I. General information

NPI: 1487190914
Provider Name (Legal Business Name): HORMONES 4 LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2017
Last Update Date: 01/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3172 WATERFRONT DR
CHATTANOOGA TN
37419-1541
US

IV. Provider business mailing address

3172 WATERFRONT DR
CHATTANOOGA TN
37419-1541
US

V. Phone/Fax

Practice location:
  • Phone: 859-321-0637
  • Fax:
Mailing address:
  • Phone: 859-321-0637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number29653
License Number StateTN

VIII. Authorized Official

Name: DR. ANDREA KAYE GALLOWAY
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 859-321-0637