=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154182228
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ISABEL PERRY WARREN PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2024
-----------------------------------------------------
Last Update Date | 02/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1726 GUNBARREL RD STE 200
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37421-4754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-954-9017
-----------------------------------------------------
Fax | 423-498-1597
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4976 ALPHA LN
-----------------------------------------------------
City | HIXSON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37343-5470
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-497-5355
-----------------------------------------------------
Fax | 423-308-0281
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 5844
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------