Provider Demographics
NPI:1134209869
Name:CHATTANOOGA PODIATRY CENTER, PC
Entity type:Organization
Organization Name:CHATTANOOGA PODIATRY CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:PICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-698-2406
Mailing Address - Street 1:1206 DODDS AVE
Mailing Address - Street 2:CHATTANOOGA PODIATRY CENTER PC
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-4754
Mailing Address - Country:US
Mailing Address - Phone:423-698-2406
Mailing Address - Fax:423-698-1667
Practice Address - Street 1:1206 DODDS AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-4754
Practice Address - Country:US
Practice Address - Phone:423-698-2406
Practice Address - Fax:423-698-1667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TN663213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3353754Medicare ID - Type UnspecifiedGROUP PRACTICE NUMBER
TN5315940001Medicare NSC