STATE OF TENNESSEE NPI 1417177528

NPI Information

STATE OF TENNESSEE is a public health or welfare in Chattanooga, TN. STATE OF TENNESSEE NPI is 1417177528. The provider is registered as an organization entity type.
The provider Is Doing Business As Southeast Tn Reg Public Health Pharmacy.

The provider's business location address is:

540 MCCALLIE AVE
SUITE 450
CHATTANOOGA, TN
ZIP 37402-089
Phone: (423) 634-3124

The provider's authorized official is Judy K Shaw .
The authorized official title is Accountant 3 and has the following contact phone number (423) 634-5832.

The CLIA number assigned to this NPI record is 44D2229076 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/30/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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