Provider Demographics
NPI:1811427032
Name:CHATTANOOGA ORTHOPAEDIC GROUP, PC
Entity type:Organization
Organization Name:CHATTANOOGA ORTHOPAEDIC GROUP, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGETT
Authorized Official - Middle Name:
Authorized Official - Last Name:AYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-624-2696
Mailing Address - Street 1:2415 MCCALLIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3322
Mailing Address - Country:US
Mailing Address - Phone:423-624-2696
Mailing Address - Fax:423-622-6249
Practice Address - Street 1:6401 LEE HWY STE 109
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2406
Practice Address - Country:US
Practice Address - Phone:423-624-2696
Practice Address - Fax:423-622-6249
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHATTANOOGA ORTHOPAEDIC GROUP, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty