Provider Demographics
NPI:1689071938
Name:CHATTANOOGA OBGYN GROUP, PLLC
Entity Type:Organization
Organization Name:CHATTANOOGA OBGYN GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:LARRY
Authorized Official - Last Name:KERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:423-326-9619
Mailing Address - Street 1:7155 LEE HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-0801
Mailing Address - Country:US
Mailing Address - Phone:423-551-3560
Mailing Address - Fax:
Practice Address - Street 1:7155 LEE HWY STE 200
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421
Practice Address - Country:US
Practice Address - Phone:423-551-3560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO1403207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty