Healthcare Provider Details

I. General information

NPI: 1588248843
Provider Name (Legal Business Name): CHATTANOOGA FOOT & ANKLE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 07/24/2021
Certification Date: 07/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1039 EXECUTIVE DR STE 102
HIXSON TN
37343-7900
US

IV. Provider business mailing address

1039 EXECUTIVE DR STE 102
HIXSON TN
37343-7900
US

V. Phone/Fax

Practice location:
  • Phone: 423-541-7000
  • Fax:
Mailing address:
  • Phone: 423-541-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIA LISSETTE PACHECO
Title or Position: MEMBER
Credential: DPM
Phone: 423-541-7000