Provider Demographics
NPI:1922119288
Name:CHATTIN PONCE, AMI HEATHER (MD)
Entity Type:Individual
Prefix:DR
First Name:AMI
Middle Name:HEATHER
Last Name:CHATTIN PONCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMI
Other - Middle Name:HEATHER
Other - Last Name:CHATTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 634706
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2333 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3258
Practice Address - Country:US
Practice Address - Phone:423-698-6061
Practice Address - Fax:865-539-8008
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD36241207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3874745Medicaid
TN4152443OtherBLUE CROSS
GA000976225AMedicaid
TN3874744Medicaid
TN4046752OtherBCBS OF TENNESSEE
AL009911918Medicaid
GA000976225BMedicaid
TNP00191712OtherRAILROAD MEDICARE
AL009909735Medicaid