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General NPI Number Information
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NPI Number | 1952485385
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Entity Type | Organization
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Legal Business Name | THE WALTER E. BOEHM BIRTH DEFECTS CENTER, INC
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 910 BLACKFORD ST
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City | CHATTANOOGA
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State | TN
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Zip | 37403-1405
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Country | US
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Telephone | 423-778-2222
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Fax | 423-778-6191
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Provider Business Mailing Address
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Address Line | 975 E 3RD ST
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City | CHATTANOOGA
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State | TN
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Zip | 37403-2103
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Country | US
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Telephone | 423-778-2222
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Fax | 423-778-6191
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SHARREE STOKER
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Credential |
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Telephone | 423-778-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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