Healthcare Provider Details

I. General information

NPI: 1780888032
Provider Name (Legal Business Name): ANDREA WARREN GOINS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 BLACKFORD ST
CHATTANOOGA TN
37403-1405
US

IV. Provider business mailing address

910 BLACKFORD ST
CHATTANOOGA TN
37403-1405
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2148
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: