Provider Demographics
NPI:1063846822
Name:KHARIWAL, POOJA
Entity Type:Individual
Prefix:
First Name:POOJA
Middle Name:
Last Name:KHARIWAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 JORDAN DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-6732
Mailing Address - Country:US
Mailing Address - Phone:423-510-1999
Mailing Address - Fax:423-510-1888
Practice Address - Street 1:101 JORDAN DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-6732
Practice Address - Country:US
Practice Address - Phone:423-510-1999
Practice Address - Fax:423-510-1888
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3417103TC0700X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist