Organization
SODDY DAISY MEDICAL CARE
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
9089 DAYTON PIKE, SODDY DAISY, TN 37379-4313
(423) 451-0622
(423) 451-0624
Mailing address
PO BOX 1059, SODDY DAISY, TN 37384-1059
(423) 451-0622
(423) 451-0624
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
TN29446
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942298559
—
TN
Enumeration date
02/02/2017
Last updated
02/02/2017
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