Provider Demographics
NPI:1629267158
Name:CHATTANOOGA ORTHOPAEDIC GROUP, PC
Entity Type:Organization
Organization Name:CHATTANOOGA ORTHOPAEDIC GROUP, PC
Other - Org Name:CENTER FOR SPORTS MEDICINE AND ORTHOPAEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:423-624-2696
Mailing Address - Street 1:2415 MCCALLIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3322
Mailing Address - Country:US
Mailing Address - Phone:423-624-2696
Mailing Address - Fax:
Practice Address - Street 1:7480 ZIEGLER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3156
Practice Address - Country:US
Practice Address - Phone:423-624-2696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies