Provider Demographics
NPI:1891832366
Name:CHATTANOOGA RADIATION ONCOLOGY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:CHATTANOOGA RADIATION ONCOLOGY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCIDMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-858-2873
Mailing Address - Street 1:PO BOX 829
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-0829
Mailing Address - Country:US
Mailing Address - Phone:706-858-2873
Mailing Address - Fax:706-858-3335
Practice Address - Street 1:475 BATTLEFIELD PARKWAY
Practice Address - Street 2:FULLER CANCER CENTER
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736
Practice Address - Country:US
Practice Address - Phone:706-858-2873
Practice Address - Fax:706-858-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0526302085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3871497Medicare ID - Type Unspecified
GA92BBFZDMedicare ID - Type Unspecified