Provider Demographics
NPI:1598190241
Name:CHILDREN'S HEALTH CENTER OF CHATTANOOGA, PC
Entity type:Organization
Organization Name:CHILDREN'S HEALTH CENTER OF CHATTANOOGA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:SKIWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-355-5107
Mailing Address - Street 1:9203 LEE HWY
Mailing Address - Street 2:STE. 113
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6458
Mailing Address - Country:US
Mailing Address - Phone:423-355-5107
Mailing Address - Fax:615-514-9647
Practice Address - Street 1:9203 LEE HWY
Practice Address - Street 2:STE. 113
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-6458
Practice Address - Country:US
Practice Address - Phone:423-355-5107
Practice Address - Fax:615-514-9647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46049208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty