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General NPI Number Information
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NPI Number | 1891832366
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Entity Type | Organization
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Legal Business Name | CHATTANOOGA RADIATION ONCOLOGY ASSOCIATES PLLC
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 475 BATTLEFIELD PARKWAY FULLER CANCER CENTER
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City | RINGGOLD
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State | GA
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Zip | 30736
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Country | US
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Telephone | 706-858-2873
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Fax | 706-858-3335
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Provider Business Mailing Address
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Address Line | PO BOX 829
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City | RINGGOLD
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State | GA
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Zip | 30736-0829
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Country | US
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Telephone | 706-858-2873
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Fax | 706-858-3335
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Authorized Official
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Title or Position | PRESIDENT
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Name | NOEL C SCIDMORE
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Credential | M.D.
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Telephone | 706-858-2873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0203X
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Taxonomy Name | Therapeutic Radiology Physician
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License Number | 052630
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License Number State | GA
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