1801237318 NPI number — LAINE WOODRUFF STEWART MOT, CHT

Table of content: LAINE WOODRUFF STEWART MOT, CHT (NPI 1801237318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801237318 NPI number — LAINE WOODRUFF STEWART MOT, CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEWART
Provider First Name:
LAINE
Provider Middle Name:
WOODRUFF
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MOT, CHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOODRUFF
Provider Other First Name:
LAINE
Provider Other Middle Name:
MARGARET
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MOT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1801237318
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6397 LEE HWY STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37421-4915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-238-7217
Provider Business Mailing Address Fax Number:
423-238-3473

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4221 OLD GENTILLY RD STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70126-4901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-435-1468
Provider Business Practice Location Address Fax Number:
504-435-1775
Provider Enumeration Date:
07/12/2013

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: 225X00000X , with the licence number:  OTT.200656 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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