Individual
DR. IMUDIA DEKONTE EHANIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
127 CRESTVIEW PARK DR STE 201, DICKSON, TN 37055-2856
(615) 441-4505
(615) 441-4515
Mailing address
127 CRESTVIEW PARK DR, DICKSON, TN 37055-2855
(615) 446-5121
(615) 446-1359
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0439349
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200655770A
—
OK
05
—
201142810A
—
KS
Enumeration date
06/17/2009
Last updated
05/09/2025
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