| Soddy Daisy Medical Care | |
|
9089 Dayton Pike Soddy Daisy TN 37379-4313 | |
| (423) 451-0622 | |
| (423) 451-0624 |
| Full Name | Soddy Daisy Medical Care |
|---|---|
| Speciality | Internal Medicine |
| Location | 9089 Dayton Pike, Soddy Daisy, Tennessee |
| Authorized Official Name and Position | Shahla A Kaukab (OWNER) |
| Authorized Official Contact | 4234510622 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Soddy Daisy Medical Care Po Box 1059 Soddy Daisy TN 37384-1059 Ph: (423) 451-0622 | Soddy Daisy Medical Care 9089 Dayton Pike Soddy Daisy TN 37379-4313 Ph: (423) 451-0622 |
| NPI Number | 1629516307 |
|---|---|
| Provider Enumeration Date | 02/02/2017 |
| Last Update Date | 02/02/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629516307 | NPI | - | NPPES |
| 1942298559 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | TN29446 (Tennessee) | Primary |
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Soddy Daisy Family Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 9089 Dayton Pike, Soddy Daisy, TN 37379 Phone: 423-451-0622 Fax: 423-451-0624 | |
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