Southern Life Healthcare PLLC
NPI 1538887401ActiveOrganization· General Practice· Chattanooga, TN
General Practice in Chattanooga, Tennessee, registered in NPPES in August 2022. The authorized official on file is Ethan Kellum, MD, Medical Director. Enrolled in Medicare as dme supplier - physician - general practice and part b supplier - clinic/group practice.
Overview
| NPI | 1538887401 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Aug 17, 2022 |
| Last updated in NPPES | Jun 13, 2024 |
| Certified by provider | Jun 13, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| General Practice Primary | 208D00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled DME Supplier - Physician - General Practice (TN); Part B Supplier - Clinic/Group Practice (TN) |
|---|
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