Provider Demographics
NPI:1740358597
Name:CHATTANOOGA PLASTIC SURGERY, PLLC
Entity type:Organization
Organization Name:CHATTANOOGA PLASTIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-826-8200
Mailing Address - Street 1:1616 GUNBARREL RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4136
Mailing Address - Country:US
Mailing Address - Phone:423-826-8200
Mailing Address - Fax:423-826-8201
Practice Address - Street 1:1616 GUNBARREL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-4136
Practice Address - Country:US
Practice Address - Phone:423-826-8200
Practice Address - Fax:423-826-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000018072208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5959415OtherAETNA
TN260118895OtherTRICARE
TN003154377OtherBLUE CROSS
TN351793500OtherUS DEPART OF LABOR
TN4953610OtherCIGNA
TN139412005329OtherHUMANA
TN1340106OtherUHC
TN602003938OtherCARITEN
TN4953610OtherCIGNA
TN602003938OtherCARITEN
TN1340106OtherUHC