MEDICARE: AWILDA MARRERO LABONNE PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363AM0700X	Medical Physician Assistant
2	208600000X	Surgery Physician
3	261QH0100X	Health Service Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356812895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AWILDA MARRERO LABONNE PLLC

Provider Business Mailing Address
First Line	:	13 W KENT ST STE 103
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37405-9913
Country	:	US
Telephone Number	:	423-648-2273
Fax Number	:	423-206-4625

Provider Business Practice Location Address
First Line	:	13 W KENT ST STE 103
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37405-9913
Country	:	US
Telephone Number	:	423-648-2273
Fax Number	:	423-206-4625

Authorized Official
Title or Position	:	CEO
Name	:	DR. AWILDA MARRERO LABONNE
Credential	:	PA-C
Telephone Number	:	423-648-2273

Provider Enumeration Date	:	12/10/2018
Last Update Date	:	12/17/2020

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