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General NPI Number Information
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NPI Number | 1083882336
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Entity Type | Organization
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Legal Business Name | COLON & RECTAL SURGERY ASSOCIATES PA
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Dates
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Enumeration Date | 02/20/2008
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Last Update Date | 02/20/2008
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Provider Practice Location Address
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Address Line | 2341 MCCALLIE AVE PLAZA 3 SUITE 305
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City | CHATTANOOGA
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State | TN
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Zip | 37404-3239
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Country | US
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Telephone | 426-622-2721
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Fax | 423-622-5368
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Provider Business Mailing Address
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Address Line | 2341 MCCALLIE AVE PLAZA 3 SUITE 305
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City | CHATTANOOGA
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State | TN
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Zip | 37404-3239
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Country | US
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Telephone | 426-622-2721
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Fax | 423-622-5368
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWIN HAYWOOD SHUCK III
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Credential | MD
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Telephone | 423-622-2721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 11816
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License Number State | TN
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