Organization
CHATTANOOGA HAMILTON COUNTY HOSPITAL AUTHORITY
Active
Other names
South Side Community Health, Southside Community Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE DALE SHAVER (DIRECTOR OF REIMBURSEMENT)
(423) 240-8576
Entity
Organization
Contact information
Practice address
3800 TENNESSEE AVE STE 124, CHATTANOOGA, TN 37409-1260
(423) 778-4780
(423) 778-4833
Mailing address
975 E THIRD STREET, CHATTANOOGA, TN 37403
(423) 778-4780
(423) 778-4833
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
0000000140
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000451481A
—
GA
Enumeration date
10/04/2006
Last updated
03/10/2022
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