Healthcare Provider Details

I. General information

NPI: 1699741595
Provider Name (Legal Business Name): SALLY ANN GRAVES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SALLY ANN VEGA CRNA

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2341 MCCALLIE AVE SUITE 402
CHATTANOOGA TN
37404-3239
US

IV. Provider business mailing address

PO BOX 3549
CHATTANOOGA TN
37404-0549
US

V. Phone/Fax

Practice location:
  • Phone: 423-698-3309
  • Fax: 423-624-6355
Mailing address:
  • Phone: 423-698-3309
  • Fax: 423-624-6355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN11183
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN60849
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN84232
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: