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General NPI Number Information
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NPI Number | 1780072371
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Entity Type | Organization
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Legal Business Name | SPECIAL CARE PODIATRY OF TENNESSEE, LLC
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Dates
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Enumeration Date | 01/05/2015
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Last Update Date | 01/06/2015
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Provider Practice Location Address
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Address Line | 6140 E BRAINERD RD
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City | CHATTANOOGA
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State | TN
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Zip | 37421-3910
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Country | US
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Telephone | 855-259-9183
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Fax | 502-254-4086
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Provider Business Mailing Address
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Address Line | 12910 SHELBYVILLE RD STE 300
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City | LOUISVILLE
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State | KY
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Zip | 40243-2404
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Country | US
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Telephone | 502-244-2441
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Fax | 502-254-4086
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Authorized Official
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Title or Position | OWNER
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Name | IRMA WEJULI
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Credential | DPM
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Telephone | 855-259-9183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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