Provider Demographics
NPI:1770770679
Name:CHATTANOOGA WOMEN'S SPECIALISTS PC
Entity type:Organization
Organization Name:CHATTANOOGA WOMEN'S SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:W
Authorized Official - Last Name:BLAES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-861-5950
Mailing Address - Street 1:2009 OLD LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:FT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-3510
Mailing Address - Country:US
Mailing Address - Phone:706-861-5950
Mailing Address - Fax:706-858-0475
Practice Address - Street 1:2009 OLD LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-3510
Practice Address - Country:US
Practice Address - Phone:706-861-5950
Practice Address - Fax:706-858-0475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207V00000X
TNMD28960174400000X
GA043319174400000X
TNDO1518174400000X
GADO052534174400000X
GADO19369174400000X
TN17843174400000X
GA27745174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP429OtherMEDICARE GROUP NUMBER
GAGRP429OtherMEDICARE GROUP NUMBER