Healthcare Provider Details

I. General information

NPI: 1396109245
Provider Name (Legal Business Name): AALOK SANJANWALA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 11/02/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 MCCALLIE AVE
CHATTANOOGA TN
37403-2724
US

IV. Provider business mailing address

902 MCCALLIE AVE
CHATTANOOGA TN
37403-2724
US

V. Phone/Fax

Practice location:
  • Phone: 423-664-4460
  • Fax:
Mailing address:
  • Phone: 404-394-0518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number67748
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: