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General NPI Number Information
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NPI Number | 1619498672
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Entity Type | Organization
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Legal Business Name | FEARFULLY AND WONDERFULLY MADE OBGYN PLLC
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Dates
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Enumeration Date | 06/29/2017
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Last Update Date | 04/28/2023
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Provider Practice Location Address
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Address Line | 4012 WEST AVE
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City | CHATTANOOGA
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State | TN
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Zip | 37410-1594
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Country | US
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Telephone | 423-498-2300
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Fax | 423-498-2301
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Provider Business Mailing Address
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Address Line | PO BOX 2217
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City | CHATTANOOGA
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State | TN
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Zip | 37409-0217
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Country | US
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Telephone | 423-498-2300
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Fax | 423-498-2301
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Authorized Official
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Title or Position | OWNER
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Name | MARY ANNA SANDERS
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Credential | DO, FACOG
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Telephone | 423-498-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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