Healthcare Provider Details

I. General information

NPI: 1902914237
Provider Name (Legal Business Name): CHATTANOOGA BARIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7405 SHALLOWFORD RD STE 160
CHATTANOOGA TN
37421-2662
US

IV. Provider business mailing address

PO BOX 1969
DALTON GA
30722-1969
US

V. Phone/Fax

Practice location:
  • Phone: 423-899-1000
  • Fax: 423-899-9824
Mailing address:
  • Phone: 706-278-6403
  • Fax: 706-278-0087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. WANDA B HOLT
Title or Position: OFFICE MANAGER
Credential:
Phone: 706-278-6403