Provider Demographics
NPI:1831146356
Name:CHATTANOOGA GYN-ONCOLOGY, LLC
Entity Type:Organization
Organization Name:CHATTANOOGA GYN-ONCOLOGY, LLC
Other - Org Name:CHATTANOOGA GYN-ONCOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:HEASTON
Authorized Official - Last Name:CHAMBERLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-698-2050
Mailing Address - Street 1:PO BOX 867
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-0867
Mailing Address - Country:US
Mailing Address - Phone:423-698-2050
Mailing Address - Fax:423-698-2095
Practice Address - Street 1:1000 E 3RD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2106
Practice Address - Country:US
Practice Address - Phone:423-698-2050
Practice Address - Fax:423-698-2095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-29
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00798311BMedicaid
TN3732814Medicaid
TN3732814Medicare ID - Type Unspecified
TN3732814Medicaid