Organization
SOUTHERN LIFE HEALTHCARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ETHAN KELLUM MD (MEDICAL DIRECTOR)
(901) 484-0837
Entity
Organization
Contact information
Practice address
6102 SHALLOWFORD RD STE 104, CHATTANOOGA, TN 37421-1684
(423) 443-6400
Mailing address
6102 SHALLOWFORD RD STE 104, CHATTANOOGA, TN 37421-1684
(423) 443-6400
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
08/17/2022
Last updated
06/13/2024
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