MEDICARE: CENTERSTONE OF CHATTANOOGA

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	251S00000X	Community/Behavioral Health Agency

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	:	1780138313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTERSTONE OF CHATTANOOGA

Provider Business Mailing Address
First Line	:	807 HURRICANE CREEK RD
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-4517
Country	:	US
Telephone Number	:	423-702-0559
Fax Number	:

Provider Business Practice Location Address
First Line	:	807 HURRICANE CREEK RD
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-4517
Country	:	US
Telephone Number	:	423-702-0559
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	TAMMIE SHULZE
Credential	:
Telephone Number	:	615-279-6746

Provider Enumeration Date	:	08/11/2016
Last Update Date	:	08/11/2016

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Directions to “CENTERSTONE OF CHATTANOOGA ” Practice Location

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