1326379751 NPI number — MRS. ELIZABETH ANN DELEONARDIS PHYSICIAN ASSISTANT

Table of content: MRS. ELIZABETH ANN DELEONARDIS PHYSICIAN ASSISTANT (NPI 1326379751)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326379751 NPI number — MRS. ELIZABETH ANN DELEONARDIS PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELEONARDIS
Provider First Name:
ELIZABETH
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTANT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHYSICIAN ASSISTANT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326379751
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1949 GUNBARREL RD
Provider Second Line Business Mailing Address:
SUITE 230
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37421-3188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-495-4345
Provider Business Mailing Address Fax Number:
423-495-4934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 CLINTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37381-4010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-365-2171
Provider Business Practice Location Address Fax Number:
423-365-5456
Provider Enumeration Date:
01/25/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1516780 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1091133 . This is a "NCCPA" identifier . This identifiers is of the category "OTHER".