Provider Demographics
NPI:1487190914
Name:HORMONES 4 LIFE LLC
Entity Type:Organization
Organization Name:HORMONES 4 LIFE LLC
Other - Org Name:CHATTANOOGA WOMEN FOR WOMEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:GALLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-321-0637
Mailing Address - Street 1:3172 WATERFRONT DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37419-1541
Mailing Address - Country:US
Mailing Address - Phone:859-321-0637
Mailing Address - Fax:
Practice Address - Street 1:3172 WATERFRONT DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37419-1541
Practice Address - Country:US
Practice Address - Phone:859-321-0637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-08
Last Update Date:2017-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29653207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ013665Medicaid
KY7100113860Medicaid
KY7100113860Medicaid