Provider Demographics
NPI:1790979177
Name:PLAZA ORTHOPAEDICS
Entity Type:Organization
Organization Name:PLAZA ORTHOPAEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:H
Authorized Official - Last Name:KING
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:423-698-4483
Mailing Address - Street 1:2339 MCCALLIE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3208
Mailing Address - Country:US
Mailing Address - Phone:423-698-4483
Mailing Address - Fax:423-698-4489
Practice Address - Street 1:2339 MCCALLIE AVE STE 201
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3208
Practice Address - Country:US
Practice Address - Phone:423-698-4483
Practice Address - Fax:423-698-4489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000007018174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty