# THE CHATTANOOGA SPINE AND WELLNESS INSTITUTE, INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** THE CHATTANOOGA SPINE AND WELLNESS INSTITUTE, INC
- **Other names:** Southeast Center for Bone and Joint
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1790370633
- **Legal business name:** THE CHATTANOOGA SPINE AND WELLNESS INSTITUTE, INC
- **Authorized official:** JESSICA NOEL TAYLOR (CLINIC DIRECTOR)
- **Authorized official phone:** (423) 296-2604

## Contact information

- **Practice address:** 6250 ABBOTTS BRIDGE RD STE 100, DULUTH, GA 30097-1713
- **Practice address phone:** (423) 296-2604
- **Practice address fax:** (423) 296-2607
- **Mailing address:** 6250 ABBOTTS BRIDGE RD STE 100, DULUTH, GA 30097-1713
- **Mailing address phone:** (423) 296-2604
- **Mailing address fax:** (423) 296-2607

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 03/03/2021
- **Last updated:** 03/03/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 3957 | MEDICARE | GA |