Provider Demographics
NPI:1659498780
Name:CHATTANOOGAHAMILTONCOHEALTHDEPT
Entity Type:Organization
Organization Name:CHATTANOOGAHAMILTONCOHEALTHDEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TB CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELIAH
Authorized Official - Middle Name:JUANICE
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:423-209-8040
Mailing Address - Street 1:7347 EDGEFIELD LN
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1423
Mailing Address - Country:US
Mailing Address - Phone:423-499-8741
Mailing Address - Fax:423-209-8031
Practice Address - Street 1:921 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2102
Practice Address - Country:US
Practice Address - Phone:423-209-8040
Practice Address - Fax:423-209-8031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000093754261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local