Organization
COLON & RECTAL SURGERY ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWIN HAYWOOD SHUCK III MD (PRESIDENT)
(423) 622-2721
Entity
Organization
Contact information
Practice address
2341 MCCALLIE AVE, PLAZA 3 SUITE 305, CHATTANOOGA, TN 37404-3239
(426) 622-2721
(423) 622-5368
Mailing address
2341 MCCALLIE AVE, PLAZA 3 SUITE 305, CHATTANOOGA, TN 37404-3239
(426) 622-2721
(423) 622-5368
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
11816
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CJ8120
RAILROAD MEDICARE GROUP
—
Enumeration date
02/20/2008
Last updated
02/20/2008
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