Provider Demographics
NPI:1598944803
Name:CHATTANOOGA OB-GYN CENTER, LLC
Entity Type:Organization
Organization Name:CHATTANOOGA OB-GYN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:423-778-8558
Mailing Address - Street 1:1751 GUNBARREL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7177
Mailing Address - Country:US
Mailing Address - Phone:423-778-8558
Mailing Address - Fax:423-778-8560
Practice Address - Street 1:1751 GUNBARREL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7177
Practice Address - Country:US
Practice Address - Phone:423-778-8558
Practice Address - Fax:423-778-8560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID