Organization
SODDY DAISY PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAHLA A KAUKAB M.D. (OWNER)
(423) 451-0622
Entity
Organization
Contact information
Practice address
8804 DAYTON PIKE STE F, SODDY DAISY, TN 37379-4306
(423) 451-0622
(423) 451-0624
Mailing address
8804 DAYTON PIKE STE F, SODDY DAISY, TN 37379-4306
(423) 451-0622
(423) 451-0624
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
37633
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3804863
—
TN
05
—
3887638
—
TN
Enumeration date
05/19/2009
Last updated
05/27/2009
Update your record
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