Provider Demographics
NPI:1760408207
Name:CHATTANOOGA CENTER FOR PAIN MEDICINE PC
Entity Type:Organization
Organization Name:CHATTANOOGA CENTER FOR PAIN MEDICINE PC
Other - Org Name:CHATTANOOGA CENTER FOR PAIN MEDICINE & REHABILITATION
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CATLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-756-7246
Mailing Address - Street 1:1012 EXECUTIVE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3993
Mailing Address - Country:US
Mailing Address - Phone:423-756-7246
Mailing Address - Fax:423-756-7247
Practice Address - Street 1:1012 EXECUTIVE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3993
Practice Address - Country:US
Practice Address - Phone:423-756-7246
Practice Address - Fax:423-756-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD12811208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3704718Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER