Healthcare Provider Details

I. General information

NPI: 1740358597
Provider Name (Legal Business Name): CHATTANOOGA PLASTIC SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 GUNBARREL RD SUITE 103
CHATTANOOGA TN
37421-4136
US

IV. Provider business mailing address

1616 GUNBARREL RD SUITE 103
CHATTANOOGA TN
37421-4136
US

V. Phone/Fax

Practice location:
  • Phone: 423-826-8200
  • Fax: 423-826-8201
Mailing address:
  • Phone: 423-826-8200
  • Fax: 423-826-8201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD0000018072
License Number StateTN

VIII. Authorized Official

Name: MRS. LINDA LEECH
Title or Position: MANAGER
Credential:
Phone: 423-826-8200