Provider Demographics
NPI:1538313853
Name:PERSONALIZED HEALTHCARE FOR WOMEN LLC
Entity Type:Organization
Organization Name:PERSONALIZED HEALTHCARE FOR WOMEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKS
Authorized Official - Suffix:
Authorized Official - Credentials:CNM, APN
Authorized Official - Phone:423-702-5581
Mailing Address - Street 1:6116 SHALLOWFORD RD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7201
Mailing Address - Country:US
Mailing Address - Phone:423-702-5581
Mailing Address - Fax:423-702-5605
Practice Address - Street 1:6116 SHALLOWFORD RD
Practice Address - Street 2:SUITE 117
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7201
Practice Address - Country:US
Practice Address - Phone:423-702-5581
Practice Address - Fax:423-702-5605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN05511367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty