Provider Demographics
NPI:1649835398
Name:PHOENIX HEALTH PLLC
Entity type:Organization
Organization Name:PHOENIX HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDMONDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:423-208-8099
Mailing Address - Street 1:7405 SHALLOWFORD RD STE 230
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7632
Mailing Address - Country:US
Mailing Address - Phone:423-280-8099
Mailing Address - Fax:855-305-1008
Practice Address - Street 1:7405 SHALLOWFORD RD STE 230
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7632
Practice Address - Country:US
Practice Address - Phone:423-280-8099
Practice Address - Fax:855-305-1008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-08
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty