Provider Demographics
NPI:1265794143
Name:GAMBLE, SHEENA KELLY (DO)
Entity type:Individual
Prefix:
First Name:SHEENA
Middle Name:KELLY
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4976 ALPHA LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5470
Mailing Address - Country:US
Mailing Address - Phone:423-497-5355
Mailing Address - Fax:423-308-0281
Practice Address - Street 1:1651 GUNBARREL RD STE 201
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3291
Practice Address - Country:US
Practice Address - Phone:423-899-9133
Practice Address - Fax:423-855-8176
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1594207V00000X
TN4544207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC015940Medicaid
SC015940Medicaid