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General NPI Number Information
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NPI Number | 1306095682
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Entity Type | Individual
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Provider Name | SUSAN MARIE PORTER AU.D.
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Gender | Female
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Dates
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Enumeration Date | 09/11/2008
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Last Update Date | 08/24/2018
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Provider Practice Location Address
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Address Line | 1618 GUNBARREL RD STE 102
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City | CHATTANOOGA
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State | TN
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Zip | 37421
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Country | US
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Telephone | 423-710-1432
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Fax | 423-710-1433
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Provider Business Mailing Address
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Address Line | 1618 GUNBARREL RD STE 102
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City | CHATTANOOGA
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State | TN
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Zip | 37421-4139
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Country | US
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Telephone | 423-710-1432
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Fax | 423-710-1433
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 1484
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 1484
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License Number State | TN
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