Healthcare Provider Details

I. General information

NPI: 1316981087
Provider Name (Legal Business Name): GASTROINTESTINAL ASSOCIATES OF CLEVELAND, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 CHAMBLISS AVE NW
CLEVELAND TN
37311-3882
US

IV. Provider business mailing address

2415 CHAMBLISS AVE NW
CLEVELAND TN
37311-3882
US

V. Phone/Fax

Practice location:
  • Phone: 423-559-2800
  • Fax: 423-559-0532
Mailing address:
  • Phone: 423-559-2800
  • Fax: 423-559-0532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN M. BOWMAN
Title or Position: PRACTICE MANAGER
Credential: FACMPE, CPC, CPMA
Phone: 423-559-2800