=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770770679
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHATTANOOGA WOMEN'S SPECIALISTS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2007
-----------------------------------------------------
Last Update Date | 08/08/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2009 OLD LAFAYETTE RD
-----------------------------------------------------
City | FORT OGLETHORPE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30742-3510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-861-5950
-----------------------------------------------------
Fax | 706-858-0475
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2009 OLD LAFAYETTE RD
-----------------------------------------------------
City | FT OGLETHORPE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30742-3510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-861-5950
-----------------------------------------------------
Fax | 706-858-0475
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | DONNA W BLAES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 706-861-5950
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------