Healthcare Provider Details

I. General information

NPI: 1659498780
Provider Name (Legal Business Name): CHATTANOOGAHAMILTONCOHEALTHDEPT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E 3RD ST
CHATTANOOGA TN
37403-2102
US

IV. Provider business mailing address

7347 EDGEFIELD LN
CHATTANOOGA TN
37421-1423
US

V. Phone/Fax

Practice location:
  • Phone: 423-209-8040
  • Fax: 423-209-8031
Mailing address:
  • Phone: 423-499-8741
  • Fax: 423-209-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License NumberRN0000093754
License Number StateTN

VIII. Authorized Official

Name: MRS. SHELIAH JUANICE RIVERS
Title or Position: TB CLINIC MANAGER
Credential: R.N.
Phone: 423-209-8040