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General NPI Number Information
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NPI Number | 1508240565
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Entity Type | Individual
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Provider Name | MR. STACY LEN WHITZELL
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Gender | Male
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Dates
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Enumeration Date | 07/19/2015
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Last Update Date | 07/19/2015
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Provider Practice Location Address
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Address Line | 5708 UPTAIN RD STE 1100
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City | CHATTANOOGA
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State | TN
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Zip | 37411-5687
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Country | US
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Telephone | 423-847-2422
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 770
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City | TRENTON
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State | GA
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Zip | 30752-0770
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Country | US
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Telephone | 423-847-2422
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Fax |
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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 | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | 1000000016408
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number | 1000000016408
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License Number State | TN
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