Provider Demographics
NPI:1932300811
Name:WESSELS ANDERSON, DELIA ANNELIZE (MD)
Entity Type:Individual
Prefix:
First Name:DELIA
Middle Name:ANNELIZE
Last Name:WESSELS ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7405 SHALLOWFORD RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2661
Mailing Address - Country:US
Mailing Address - Phone:423-602-9545
Mailing Address - Fax:423-602-9546
Practice Address - Street 1:7405 SHALLOWFORD RD
Practice Address - Street 2:SUITE 270
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2661
Practice Address - Country:US
Practice Address - Phone:423-602-9545
Practice Address - Fax:423-602-9546
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88380208000000X
NV12721208000000X
TN49755208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1532239Medicaid