Provider Demographics
NPI:1659379451
Name:CHATTANOOGA EAR NOSE & THROAT ASSOC., P.C.
Entity Type:Organization
Organization Name:CHATTANOOGA EAR NOSE & THROAT ASSOC., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:EWELL
Authorized Official - Last Name:GREER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-698-8981
Mailing Address - Street 1:901 RIVERFRONT PARKWAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402
Mailing Address - Country:US
Mailing Address - Phone:423-698-8981
Mailing Address - Fax:423-697-7109
Practice Address - Street 1:901 RIVERFRONT PARKWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402
Practice Address - Country:US
Practice Address - Phone:423-698-8981
Practice Address - Fax:423-697-7109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3377541Medicare ID - Type Unspecified