MEDICARE: MADELYN G CHADWELL

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1689147811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELYN G CHADWELL

Provider Business Mailing Address
First Line	:	156 W HILLS DR
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37419-2240
Country	:	US
Telephone Number	:	615-944-6594
Fax Number	:

Provider Business Practice Location Address
First Line	:	156 W HILLS DR
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37419-2240
Country	:	US
Telephone Number	:	615-944-6594
Fax Number	:

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

Provider Enumeration Date	:	01/10/2019
Last Update Date	:	01/10/2019

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