Healthcare Provider Details

I. General information

NPI: 1215172879
Provider Name (Legal Business Name): CHATTANOOGA HAMILTON COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 N LYERLY ST STE 300
CHATTANOOGA TN
37404-2743
US

IV. Provider business mailing address

975 E 3RD ST
CHATTANOOGA TN
37403-2147
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-4712
  • Fax:
Mailing address:
  • Phone: 423-778-4780
  • Fax: 423-778-4833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES BRITTON TABOR
Title or Position: EXECUTIVE VP & CFO/TREASURER
Credential:
Phone: 423-778-7729