Provider Demographics
NPI:1124024534
Name:CHATTANOOGA GASTROENTEROLOGY, PC
Entity Type:Organization
Organization Name:CHATTANOOGA GASTROENTEROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SADOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-493-9151
Mailing Address - Street 1:2341 MCCALLIE AVENUE
Mailing Address - Street 2:PLAZA THREE, SUITE 400
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404
Mailing Address - Country:US
Mailing Address - Phone:423-493-9151
Mailing Address - Fax:423-493-9551
Practice Address - Street 1:2341 MCCALLIE AVENUE
Practice Address - Street 2:PLAZA THREE, SUITE 400
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404
Practice Address - Country:US
Practice Address - Phone:423-493-9151
Practice Address - Fax:423-493-9551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25915207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3374865Medicare PIN
GAGRP6755Medicare PIN