Healthcare Provider Details

I. General information

NPI: 1356812895
Provider Name (Legal Business Name): AWILDA MARRERO LABONNE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 W KENT ST STE 103
CHATTANOOGA TN
37405-9913
US

IV. Provider business mailing address

13 W KENT ST STE 103
CHATTANOOGA TN
37405-9913
US

V. Phone/Fax

Practice location:
  • Phone: 423-648-2273
  • Fax: 423-206-4625
Mailing address:
  • Phone: 423-648-2273
  • Fax: 423-206-4625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. AWILDA MARRERO LABONNE
Title or Position: CEO
Credential: PA-C
Phone: 423-648-2273