Healthcare Provider Details

I. General information

NPI: 1174795645
Provider Name (Legal Business Name): BEACON HEALTH ALLIANCE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 HAMILL RD SUITE 110B
HIXSON TN
37343-6614
US

IV. Provider business mailing address

PO BOX 6159
CHATTANOOGA TN
37401-6159
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-9500
  • Fax: 423-778-9575
Mailing address:
  • Phone: 423-495-4939
  • Fax: 423-495-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SHEILA MANLEY
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 423-495-4806