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General NPI Number Information
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NPI Number | 1023684826
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Entity Type | Organization
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Legal Business Name | ATHENA ESOTERIX, LLC.
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Dates
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Enumeration Date | 06/02/2021
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Last Update Date | 04/18/2022
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Provider Practice Location Address
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Address Line | 1247 RIVERFRONT PKWY STE 212
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City | CHATTANOOGA
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State | TN
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Zip | 37402-2108
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Country | US
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Telephone | 423-206-7091
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Fax |
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Provider Business Mailing Address
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Address Line | 1247 RIVERFRONT PKWY STE 212
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City | CHATTANOOGA
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State | TN
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Zip | 37402-2108
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Country | US
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Telephone | 423-206-7091
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Fax |
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Authorized Official
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Title or Position | FOUNDER/TECHNICAL DIRECTOR
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Name | DR. ELIZABETH HAMILTON FORRESTER
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Credential | PH.D.
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Telephone | 423-645-0007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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