Provider Demographics
NPI:1477692549
Name:CHATTANOOGA HAMILTON COUNTY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:CHATTANOOGA HAMILTON COUNTY HOSPITAL AUTHORITY
Other - Org Name:ERLANGER SOUTH FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:TABOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-778-7729
Mailing Address - Street 1:PO BOX 11565
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401-2565
Mailing Address - Country:US
Mailing Address - Phone:423-778-3274
Mailing Address - Fax:413-622-0141
Practice Address - Street 1:60 ERLANGER SOUTH DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-3179
Practice Address - Country:US
Practice Address - Phone:706-937-9292
Practice Address - Fax:706-937-7207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6422Medicare PIN