Healthcare Provider Details

I. General information

NPI: 1366507360
Provider Name (Legal Business Name): CHATTANOOGA PODIATRY CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N HOLTZCLAW AVE SUITE 210
CHATTANOOGA TN
37404-1242
US

IV. Provider business mailing address

600 N HOLTZCLAW AVE SUITE 210
CHATTANOOGA TN
37404-1242
US

V. Phone/Fax

Practice location:
  • Phone: 423-698-2406
  • Fax: 423-698-1667
Mailing address:
  • Phone: 423-698-2406
  • Fax: 423-698-1667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number663
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ARLENE JOY PICKETT
Title or Position: CORPORATE OFFICER
Credential:
Phone: 423-698-2407