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6221 Shallowford Rd Ste 100 Chattanooga TN 37421-1972 | |
| (423) 541-9455 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | General Practice |
| Location | 6221 Shallowford Rd Ste 100, Chattanooga, Tennessee |
| Authorized Official Name and Position | Candice Crawford (OWNER) |
| Authorized Official Contact | 4048394566 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
6221 Shallowford Rd Ste 102 Chattanooga TN 37421-1972 Ph: (404) 839-4566 | 6221 Shallowford Rd Ste 100 Chattanooga TN 37421-1972 Ph: (423) 541-9455 |
| NPI Number | 1023894623 |
|---|---|
| Provider Enumeration Date | 09/07/2023 |
| Last Update Date | 01/12/2025 |
| Medicare PECOS PAC ID | 7719337989 |
|---|---|
| Medicare Enrollment ID | O20231229002296 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023894623 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Jessica Marie Rose |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710592035 PECOS PAC ID: 6305257510 Enrollment ID: I20201119000986 |
| Provider Name | Trudie C Li |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215331913 PECOS PAC ID: 9537484472 Enrollment ID: I20221118002868 |
| Provider Name | Candice Alisha Crawford |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1700133394 PECOS PAC ID: 2062881790 Enrollment ID: I20221219002838 |
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