MEDICARE: JORGE ENRIQUE ORDONEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	14915	TN
2	207V00000X	Obstetrics & Gynecology Physician	MD14915	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0152247	OTHER	TN	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	14915	OTHER	TN	MEDICAL LICENSE
4	024611	OTHER	GA	GEORGIA MEDICAL LICENSE

General Provider Information

NPI Number	:	1003865346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE ENRIQUE ORDONEZ M.D.

Provider Business Mailing Address
First Line	:	6350 W ANDREW JOHNSON HWY
Second Line	:	DEPARTMENT 100
City	:	TALBOTT
State	:	TN
Zip	:	37877-8605
Country	:	US
Telephone Number	:	800-355-3565
Fax Number	:	423-714-2355

Provider Business Practice Location Address
First Line	:	1032 MCCALLIE AVE
Second Line	:	SUITE 100
City	:	CHATTANOOGA
State	:	TN
Zip	:	37403-2800
Country	:	US
Telephone Number	:	423-266-4588
Fax Number	:	865-342-0103

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	03/08/2026

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Directions to “ JORGE ENRIQUE ORDONEZ M.D.” Practice Location

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