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General NPI Number Information
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NPI Number | 1487190914
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Entity Type | Organization
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Legal Business Name | HORMONES 4 LIFE LLC
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Dates
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Enumeration Date | 01/08/2017
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Last Update Date | 01/08/2017
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Provider Practice Location Address
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Address Line | 3172 WATERFRONT DR
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City | CHATTANOOGA
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State | TN
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Zip | 37419-1541
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Country | US
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Telephone | 859-321-0637
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Fax |
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Provider Business Mailing Address
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Address Line | 3172 WATERFRONT DR
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City | CHATTANOOGA
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State | TN
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Zip | 37419-1541
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Country | US
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Telephone | 859-321-0637
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. ANDREA KAYE GALLOWAY
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Credential | MD
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Telephone | 859-321-0637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 29653
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License Number State | TN
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