Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 57517 | TN |
NPI | 1073801965 |
---|---|
Provider Name | Randi Shae Connor |
First Address | Chattanooga, TN 37403-1503 |
Second Address | Chattanooga, TN 37403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2011 |
Last Update Date | 26/06/2018 |