Healthcare Provider Details

I. General information

NPI: 1699079673
Provider Name (Legal Business Name): LIFESPRING COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 05/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2507 MCCALLIE AVE
CHATTANOOGA TN
37404-3304
US

IV. Provider business mailing address

2507 MCCALLIE AVE
CHATTANOOGA TN
37404-3304
US

V. Phone/Fax

Practice location:
  • Phone: 423-624-4846
  • Fax: 423-624-4847
Mailing address:
  • Phone: 423-624-4846
  • Fax: 423-624-4847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number26074
License Number StateTN

VIII. Authorized Official

Name: DR. MICHELE ALBURY PICKETT
Title or Position: EXECUTIVE DIRECTOR
Credential: M.D.
Phone: 423-304-4525