Provider Demographics
NPI:1396288890
Name:RENU CHATTANOOGA, PLLC
Entity type:Organization
Organization Name:RENU CHATTANOOGA, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:NICOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-243-3342
Mailing Address - Street 1:979 E 3RD ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2136
Mailing Address - Country:US
Mailing Address - Phone:423-243-3330
Mailing Address - Fax:423-648-6487
Practice Address - Street 1:5870 HIGHWAY 153 STE 122
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5826
Practice Address - Country:US
Practice Address - Phone:423-243-3342
Practice Address - Fax:423-402-8155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-01
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000037970207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty