Basic Information
| Provider Information | |||||||||
| NPI: | 1467862649 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DYER | ||||||||
| FirstName: | ALICIA | ||||||||
| MiddleName: | DANIELS | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | DANIELS | ||||||||
| OtherFirstName: | HEATHER | ||||||||
| OtherMiddleName: | ALICIA | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1949 GUNBARREL ROAD | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234954349 | ||||||||
| FaxNumber: | 4234954934 | ||||||||
| Practice Location | |||||||||
| Address1: | CHI MEMORIAL PEDIATRIC DIAGNOSTIC ASSOCIATES | ||||||||
| Address2: | 4700 BATTLEFIELD PARKWAY, SUITE 230 | ||||||||
| City: | RINGGOLD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236982229 | ||||||||
| FaxNumber: | 4236220619 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2014 | ||||||||
| LastUpdateDate: | 05/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 078283 | GA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.