Provider Demographics
NPI:1417391756
Name:WILSON, CATHERINE KEEGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:KEEGAN
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:ANNE
Other - Last Name:KEEGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4976 ALPHA LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5470
Mailing Address - Country:US
Mailing Address - Phone:423-308-0280
Mailing Address - Fax:423-308-0281
Practice Address - Street 1:3354 CHARGER DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37409-1265
Practice Address - Country:US
Practice Address - Phone:423-265-6411
Practice Address - Fax:423-756-4044
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN54643208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics