Provider Demographics
NPI:1548563406
Name:MIDTOWN HEALTHCARE, LLC
Entity Type:Organization
Organization Name:MIDTOWN HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER - CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:AFTAB
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:725-255-2336
Mailing Address - Street 1:P.O BOX 6101
Mailing Address - Street 2:910 GEORGIA AVE
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402
Mailing Address - Country:US
Mailing Address - Phone:423-650-4042
Mailing Address - Fax:561-948-4484
Practice Address - Street 1:2412 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3398
Practice Address - Country:US
Practice Address - Phone:423-698-0221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44115207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty