Provider Demographics
NPI:1619949666
Name:CNTR FOR DIGESTIVE DISORDERS & CLINICAL REASEARCH
Entity Type:Organization
Organization Name:CNTR FOR DIGESTIVE DISORDERS & CLINICAL REASEARCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-698-0254
Mailing Address - Street 1:2341 MCCALLIE AVENUE
Mailing Address - Street 2:PLAZA 3 SUITE 201
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404
Mailing Address - Country:US
Mailing Address - Phone:423-698-0254
Mailing Address - Fax:423-698-4762
Practice Address - Street 1:2341 MCCALLIE AVENUE
Practice Address - Street 2:PLAZA 3 SUITE 201
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404
Practice Address - Country:US
Practice Address - Phone:423-698-0254
Practice Address - Fax:423-698-4762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3703122Medicare ID - Type Unspecified