Organization
MOSE AND GARRISON SISKIN MEMORIAL FOUNDATION, INC.
Active
Parent organization
MOSE AND GARRISON SISKIN MEMORIAL FOUNDATION, INC.
Other names
Siskin Center for Developmental Pediatrics
Organization subpart
Yes
Provider details
NPI number
Legal business name
MOSE AND GARRISON SISKIN MEMORIAL FOUNDATION, INC.
Authorized official
STEPHANIE COOPER-WILKES (DIRECTOR HEALTHCARE ADMINISTRATION)
(423) 490-7727
Entity
Organization
Contact information
Practice address
1101 CARTER ST, CHATTANOOGA, TN 37402-5017
(423) 490-7710
(423) 490-7750
Mailing address
1101 CARTER ST, CHATTANOOGA, TN 37402-5017
(423) 490-7710
(423) 490-7750
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
2080P0006X
Developmental - Behavioral Pediatrics Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003136978A
—
GA
05
—
1527698
—
TN
Enumeration date
11/02/2009
Last updated
10/25/2019
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