Provider Demographics
NPI:1255760484
Name:CALDWELL, QUINNETTA L
Entity type:Individual
Prefix:
First Name:QUINNETTA
Middle Name:L
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6215 LEE HWY
Mailing Address - Street 2:SUITE K
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2916
Mailing Address - Country:US
Mailing Address - Phone:423-386-5455
Mailing Address - Fax:
Practice Address - Street 1:6215 LEE HWY
Practice Address - Street 2:SUITE K
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2916
Practice Address - Country:US
Practice Address - Phone:423-386-5455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver