Provider Demographics
NPI:1174799431
Name:TENNESSEE VALLEY FOOT AND ANKLE CENTER
Entity type:Organization
Organization Name:TENNESSEE VALLEY FOOT AND ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:STRICKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-559-8000
Mailing Address - Street 1:709 CANDLEWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2064
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 GROSS CRESCENT CIR
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-3600
Practice Address - Country:US
Practice Address - Phone:706-858-0766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA799213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA035007OtherBCBS
GACK8464OtherMEDICARE RR
GA000959857AMedicaid
GACK8464OtherMEDICARE RR
GA035007OtherBCBS
U62049Medicare UPIN