Healthcare Provider Details

I. General information

NPI: 1285277046
Provider Name (Legal Business Name): CANCER RISK ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 DUNHILL PL NW STE A
CLEVELAND TN
37311-3870
US

IV. Provider business mailing address

PO BOX 22464
CHATTANOOGA TN
37422-2464
US

V. Phone/Fax

Practice location:
  • Phone: 423-541-6195
  • Fax:
Mailing address:
  • Phone: 706-271-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CATHERINE MARCUM
Title or Position: APN
Credential: APN
Phone: 423-541-6195