Healthcare Provider Details

I. General information

NPI: 1033477401
Provider Name (Legal Business Name): KATHRYN CHARLTON HINES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 06/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 BLACKFORD ST
CHATTANOOGA TN
37403-1405
US

IV. Provider business mailing address

975 EAST THIRD STREET ATTN: PROVIDER ENROLLMENT
CHATTANOOGA TN
37403-2147
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-6107
  • Fax: 423-778-6958
Mailing address:
  • Phone: 423-778-6107
  • Fax: 423-778-6958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.32649
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number55887
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: