Healthcare Provider Details

I. General information

NPI: 1417391756
Provider Name (Legal Business Name): CATHERINE KEEGAN WILSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CATHERINE ANNE KEEGAN

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3354 CHARGER DR
CHATTANOOGA TN
37409-1265
US

IV. Provider business mailing address

4976 ALPHA LN
HIXSON TN
37343-5470
US

V. Phone/Fax

Practice location:
  • Phone: 423-265-6411
  • Fax: 423-756-4044
Mailing address:
  • Phone: 423-308-0280
  • Fax: 423-308-0281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number54643
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: