Provider Demographics
NPI:1134513484
Name:NEELY, ERIN HARTSFIELD (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:HARTSFIELD
Last Name:NEELY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 GESWEIN CT
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-1755
Mailing Address - Country:US
Mailing Address - Phone:334-797-1685
Mailing Address - Fax:
Practice Address - Street 1:1010 E 3RD ST STE 202
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2174
Practice Address - Country:US
Practice Address - Phone:423-265-2233
Practice Address - Fax:423-756-8265
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05658363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2159PAMedicaid
NC1134513484Medicaid
NCNCN594AMedicare PIN
SC2159PAMedicaid
NCNCN594CMedicare PIN
NCNCN594DMedicare PIN