Organization
JAFFE SHOE STORES, INC.
Active
Other names
sonny sanders, c.ped
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SONNY SANDERS C.PED (PRESIDENT/CERTIIED PEDORTHIST)
(423) 892-3366
Entity
Organization
Contact information
Practice address
5726 MARLIN RD, SUITE 512, CHATTANOOGA, TN 37411-4008
(423) 892-3366
(423) 892-3337
Mailing address
PO BOX 80024, CHATTANOOGA, TN 37414-7024
(423) 892-3366
(423) 892-3337
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
NO STATE LICENSURE
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1454284
—
TN
01
—
4043199
BLUE CROSS
TN
Enumeration date
08/27/2005
Last updated
08/22/2020
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