Healthcare Provider Details

I. General information

NPI: 1104958487
Provider Name (Legal Business Name): ASSOCIATES IN GENERAL SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 GLENWOOD DR. SUITE W-462
CHATTANOOGA TN
37404
US

IV. Provider business mailing address

PO BOX 867
CHATTANOOGA TN
37401-0867
US

V. Phone/Fax

Practice location:
  • Phone: 423-362-4554
  • Fax: 423-362-4550
Mailing address:
  • Phone: 423-362-4554
  • Fax: 423-362-4550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number43386
License Number StateGA

VIII. Authorized Official

Name: DANIEL L. HEITHOLD
Title or Position: OWNER
Credential: MD
Phone: 423-362-4554