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General NPI Number Information
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NPI Number | 1518942341
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Entity Type | Individual
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Provider Name | ANTHONY AVITABILE JR. DO
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Gender | Male
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 6043 SHALLOWFORD RD STE 101
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City | CHATTANOOGA
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State | TN
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Zip | 37421-1653
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Country | US
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Telephone | 423-802-1919
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Fax | 423-269-6178
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Provider Business Mailing Address
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Address Line | PO BOX 307
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City | HIXSON
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State | TN
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Zip | 37343-0307
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Country | US
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Telephone | 423-802-1919
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Fax | 423-269-6178
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 1218
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1218
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License Number State | TN
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