Provider Demographics
NPI:1740440445
Name:HUTSON, SHARLISA WALLER (MD)
Entity type:Individual
Prefix:
First Name:SHARLISA
Middle Name:WALLER
Last Name:HUTSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11503
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401-2503
Mailing Address - Country:US
Mailing Address - Phone:423-778-6472
Mailing Address - Fax:423-778-4232
Practice Address - Street 1:910 BLACKFORD STREET
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403
Practice Address - Country:US
Practice Address - Phone:423-778-6472
Practice Address - Fax:423-778-4232
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2015-08-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN502422084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology