Provider Demographics
NPI:1851691281
Name:CHILDRESS & MEYER, PLLC
Entity Type:Organization
Organization Name:CHILDRESS & MEYER, PLLC
Other - Org Name:EAST BRAINERD ORAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:423-296-8210
Mailing Address - Street 1:1350 MACKEY BRANCH DRIVE
Mailing Address - Street 2:ST. 110
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421
Mailing Address - Country:US
Mailing Address - Phone:423-396-8210
Mailing Address - Fax:423-296-8292
Practice Address - Street 1:1350 MACKEY BRANCH DRIVE
Practice Address - Street 2:ST. 110
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3482
Practice Address - Country:US
Practice Address - Phone:423-296-8210
Practice Address - Fax:423-296-8292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1521422Medicaid