Provider Demographics
NPI:1487747457
Name:CHATTANOOGA FOOT SPECIALISTS, PLLC
Entity type:Organization
Organization Name:CHATTANOOGA FOOT SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAMACK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:423-698-4899
Mailing Address - Street 1:2707 CITICO AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37406-3402
Mailing Address - Country:US
Mailing Address - Phone:423-698-4899
Mailing Address - Fax:423-698-8269
Practice Address - Street 1:2707 CITICO AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37406-3402
Practice Address - Country:US
Practice Address - Phone:843-628-0023
Practice Address - Fax:423-698-8269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN590213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5212310002Medicare PIN
TN5212310001Medicare NSC
5212310002Medicare NSC
TN3724545Medicare PIN
TN5212310001Medicare PIN