Individual
MR. STACY LEN WHITZELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5708 UPTAIN RD STE 1100, CHATTANOOGA, TN 37411-5687
(423) 847-2422
Mailing address
PO BOX 770, TRENTON, GA 30752-0770
(423) 847-2422
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
1000000016408
TN
3747P1801X
Personal Care Attendant
1000000016408
TN
Other
Enumeration date
07/19/2015
Last updated
07/19/2015
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