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General NPI Number Information
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NPI Number | 1356812895
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Entity Type | Organization
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Legal Business Name | AWILDA MARRERO LABONNE PLLC
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Dates
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Enumeration Date | 12/10/2018
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Last Update Date | 12/17/2020
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Provider Practice Location Address
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Address Line | 13 W KENT ST STE 103
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City | CHATTANOOGA
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State | TN
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Zip | 37405-9913
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Country | US
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Telephone | 423-648-2273
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Fax | 423-206-4625
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Provider Business Mailing Address
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Address Line | 13 W KENT ST STE 103
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City | CHATTANOOGA
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State | TN
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Zip | 37405-9913
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Country | US
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Telephone | 423-648-2273
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Fax | 423-206-4625
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Authorized Official
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Title or Position | CEO
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Name | DR. AWILDA MARRERO LABONNE
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Credential | PA-C
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Telephone | 423-648-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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