MEDICARE: CASSIE LEE DAHLIN PA-C

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	363A00000X	Physician Assistant	2234	TN

General Provider Information

NPI Number	:	1467705681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIE LEE DAHLIN PA-C

Provider Business Mailing Address
First Line	:	1949 GUNBARREL RD STE 230
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-3187
Country	:	US
Telephone Number	:	423-495-4349
Fax Number	:	423-495-4934

Provider Business Practice Location Address
First Line	:	645 PAUL HUFF PKWY NW STE 105
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3150
Country	:	US
Telephone Number	:	423-790-7750
Fax Number	:	423-790-7659

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

Provider Enumeration Date	:	10/25/2012
Last Update Date	:	03/17/2018

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