MEDICARE: KATESSA ANGEL BUCHANAN MSW

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1073281671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATESSA ANGEL BUCHANAN MSW

Provider Business Mailing Address
First Line	:	6110 SHALLOWFORD RD STE B
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-1894
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6110 SHALLOWFORD RD STE B
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-1894
Country	:	US
Telephone Number	:	888-291-4357
Fax Number	:

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

Provider Enumeration Date	:	08/31/2021
Last Update Date	:	01/26/2026

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