Provider Demographics
NPI:1609974419
Name:BETTS, EUGENE KOHLER (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:KOHLER
Last Name:BETTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28068
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37424-8068
Mailing Address - Country:US
Mailing Address - Phone:877-899-1033
Mailing Address - Fax:423-892-5838
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:BI-2190
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-3873
Practice Address - Fax:706-721-7763
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045398207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000790006CMedicaid
GA050090637OtherRAILROAD MEDICARE
GA000790006BMedicaid
SCQ15066Medicaid
GA339266OtherWELLCARE CMO
GA550789920OtherTRICARE
GA598095OtherBCBS
B40221Medicare UPIN
GA000790006CMedicaid