Organization
NURTURED LIVING OF CHATTANOOGA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANDREA G JACKSON LICENSED PRACTICAL N (DIRECTOR)
(423) 304-1847
Entity
Organization
Contact information
Practice address
1301 WOODMORE LANE, CHATTANOOGA, TN 37411
(423) 624-2060
(423) 624-2055
Mailing address
1301 WOODMORE LANE, CHATTANOOGA, TN 37411
(423) 624-2060
(423) 624-2055
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
1438-058-9179
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
H445217
—
TN
Enumeration date
02/17/2009
Last updated
02/17/2009
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