Provider Demographics
NPI:1194776914
Name:COVENANT EMERGENCY PHYSICIANS LLC
Entity type:Organization
Organization Name:COVENANT EMERGENCY PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHETTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-754-3113
Mailing Address - Street 1:480 BARRON DR
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-5501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:706-754-1011
Practice Address - Street 1:541 HISTORIC HWY 441
Practice Address - Street 2:ER DEPARTMENT
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535
Practice Address - Country:US
Practice Address - Phone:706-754-3113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADE8501OtherRRGA
GAGRP7726Medicare PIN