Organization
SODDY DAISY FAMILY CARE
Active
Other names
Soddy Daisy Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHAHLA A KAUKAB MD (OWNER)
(423) 451-0623
Entity
Organization
Contact information
Practice address
9089 DAYTON PIKE, SODDY DAISY, TN 37379-4313
(423) 451-0622
(423) 451-0624
Mailing address
9089 DAYTON PIKE, SODDY DAISY, TN 37379
(423) 451-0622
(423) 451-0624
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
29446
TN
208000000X
Pediatrics Physician
28243
TN
208000000X
Pediatrics Physician
Primary
37633
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1509389
—
TN
05
—
1511723
—
TN
05
—
3887638
—
TN
Enumeration date
03/04/2013
Last updated
05/12/2017
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