Healthcare Provider Details

I. General information

NPI: 1730313404
Provider Name (Legal Business Name): CHATTANOOGA RADIATION ONCOLOGY CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 05/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 GLENWOOD DR SUITE 212
CHATTANOOGA TN
37404-1108
US

IV. Provider business mailing address

605 GLENWOOD DR SUITE 212
CHATTANOOGA TN
37404-1108
US

V. Phone/Fax

Practice location:
  • Phone: 423-697-9890
  • Fax: 423-697-9891
Mailing address:
  • Phone: 423-697-9890
  • Fax: 423-697-9891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DIANNE L TUCKER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 423-697-9890