Provider Demographics
NPI:1669664652
Name:GATES, GINGER (CRNA)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:
Last Name:GATES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11225
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401-2225
Mailing Address - Country:US
Mailing Address - Phone:423-892-5602
Mailing Address - Fax:423-892-5838
Practice Address - Street 1:975 E. THIRD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2147
Practice Address - Country:US
Practice Address - Phone:423-778-7806
Practice Address - Fax:423-778-2360
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN146750163W00000X
GARN134570163W00000X
TNAPN12890367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA308968198AMedicaid
GAN417117OtherWELLCARE (GA MEDICAID)
NC8053441Medicaid
AL009912932Medicaid
TN3600105Medicaid
TNP00472264OtherRAILROAD MEDICARE
TN4167291OtherBLUE CROSS BLUE SHIELD TN
GA308968198AMedicaid