Provider Demographics
NPI:1104537562
Name:NPONTHEGO BY D ONEIL
Entity type:Organization
Organization Name:NPONTHEGO BY D ONEIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:CANTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-413-3832
Mailing Address - Street 1:1147 SADDLEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-1939
Mailing Address - Country:US
Mailing Address - Phone:423-834-2756
Mailing Address - Fax:
Practice Address - Street 1:7161 LEE HWY STE 400
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-8604
Practice Address - Country:US
Practice Address - Phone:423-708-8670
Practice Address - Fax:423-708-8671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-07
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty