| Dodson Avenue Community Health | |
|
1200 Dodson Ave Chattanooga TN 37406 | |
| (423) 778-4780 | |
| (423) 778-4833 |
| Full Name | Dodson Avenue Community Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 1200 Dodson Ave, Chattanooga, Tennessee |
| Authorized Official Name and Position | James L Brexler (PRESIDENT AND CEO) |
| Authorized Official Contact | 4237784780 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dodson Avenue Community Health 975 E Third St Chattanooga TN 37403 Ph: (423) 778-4780 | Dodson Avenue Community Health 1200 Dodson Ave Chattanooga TN 37406 Ph: (423) 778-4780 |
| NPI Number | 1609961549 |
|---|---|
| Provider Enumeration Date | 10/04/2006 |
| Last Update Date | 02/27/2008 |
| Medicare PECOS PAC ID | 0547179731 |
|---|---|
| Medicare Enrollment ID | O20050421001576 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609961549 | NPI | - | NPPES |
| 00451492A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 0000000140 (Tennessee) | Primary |
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