Healthcare Provider Details

I. General information

NPI: 1548627912
Provider Name (Legal Business Name): ANISHA E MATHI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2016
Last Update Date: 11/27/2023
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2358 LIFESTYLE WAY STE 212
CHATTANOOGA TN
37421-2291
US

IV. Provider business mailing address

2358 LIFESTYLE WAY STE 212
CHATTANOOGA TN
37421-2291
US

V. Phone/Fax

Practice location:
  • Phone: 423-521-1100
  • Fax: 423-521-1200
Mailing address:
  • Phone: 423-521-1100
  • Fax: 423-521-1200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3273
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: