Basic Information
| Provider Information | |||||||||
| NPI: | 1336132679 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BETTS | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1949 GUNBARREL RD STE 206 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374217133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234954345 | ||||||||
| FaxNumber: | 4234954934 | ||||||||
| Practice Location | |||||||||
| Address1: | 611 E VILLANOW ST | ||||||||
| Address2: | |||||||||
| City: | LA FAYETTE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307282618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066381606 | ||||||||
| FaxNumber: | 7066389987 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2005 | ||||||||
| LastUpdateDate: | 05/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01050866A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 82964 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.