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General NPI Number Information
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NPI Number | 1770915928
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Entity Type | Organization
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Legal Business Name | CHATTANOOGA SPORTS INSTITUTE
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Dates
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Enumeration Date | 07/30/2013
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Last Update Date | 07/30/2013
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Provider Practice Location Address
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Address Line | 4206 N ACCESS RD
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City | CHATTANOOGA
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State | TN
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Zip | 37415-3801
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Country | US
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Telephone | 423-472-7938
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Fax |
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Provider Business Mailing Address
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Address Line | 4206 N ACCESS RD
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City | CHATTANOOGA
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State | TN
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Zip | 37415-3801
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIELLE MITCHELL
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Credential | MD
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Telephone | 423-472-7938
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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