Provider Demographics
NPI:1528184744
Name:CHATTANOOGA SURGICAL ONCOLOGY AND ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:CHATTANOOGA SURGICAL ONCOLOGY AND ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTERA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:423-622-2494
Mailing Address - Street 1:721 GLENWOOD DR
Mailing Address - Street 2:SUITE 471W
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1106
Mailing Address - Country:US
Mailing Address - Phone:423-622-2494
Mailing Address - Fax:423-622-4532
Practice Address - Street 1:721 GLENWOOD DR
Practice Address - Street 2:SUITE 471W
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1106
Practice Address - Country:US
Practice Address - Phone:423-622-2494
Practice Address - Fax:423-622-4532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Not Answered2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3723223Medicare ID - Type Unspecified