Healthcare Provider Details

I. General information

NPI: 1851863930
Provider Name (Legal Business Name): CASSANDRA RENE GILES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2018
Last Update Date: 12/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 DESALES AVE
CHATTANOOGA TN
37404-1161
US

IV. Provider business mailing address

1949 GUNBARREL RD STE 206
CHATTANOOGA TN
37421-3188
US

V. Phone/Fax

Practice location:
  • Phone: 423-495-7404
  • Fax: 423-495-2625
Mailing address:
  • Phone: 423-495-4349
  • Fax: 423-495-4934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN228291
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: