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General NPI Number Information
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NPI Number | 1699079673
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Entity Type | Organization
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Legal Business Name | LIFESPRING COMMUNITY HEALTH
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Dates
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Enumeration Date | 01/05/2011
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Last Update Date | 05/11/2012
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Provider Practice Location Address
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Address Line | 2507 MCCALLIE AVE
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City | CHATTANOOGA
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State | TN
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Zip | 37404-3304
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Country | US
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Telephone | 423-624-4846
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Fax | 423-624-4847
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Provider Business Mailing Address
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Address Line | 2507 MCCALLIE AVE
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City | CHATTANOOGA
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State | TN
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Zip | 37404-3304
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Country | US
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Telephone | 423-624-4846
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Fax | 423-624-4847
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. MICHELE ALBURY PICKETT
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Credential | M.D.
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Telephone | 423-304-4525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 26074
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License Number State | TN
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