1467862649 NPI number — MRS. ALICIA DANIELS DYER MD

Table of content: MRS. ALICIA DANIELS DYER MD (NPI 1467862649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467862649 NPI number — MRS. ALICIA DANIELS DYER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DYER
Provider First Name:
ALICIA
Provider Middle Name:
DANIELS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DANIELS
Provider Other First Name:
HEATHER
Provider Other Middle Name:
ALICIA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467862649
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1949 GUNBARREL ROAD
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
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-495-4349
Provider Business Mailing Address Fax Number:
423-495-4934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CHI MEMORIAL PEDIATRIC DIAGNOSTIC ASSOCIATES
Provider Second Line Business Practice Location Address:
4700 BATTLEFIELD PARKWAY, SUITE 230
Provider Business Practice Location Address City Name:
RINGGOLD
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-698-2229
Provider Business Practice Location Address Fax Number:
423-622-0619
Provider Enumeration Date:
04/28/2014

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: 208000000X , with the licence number:  078283 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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