Individual
DR. SHAHLA AMJAD KAUKAB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
9089 DAYTON PIKE, SODDY DAISY, TN 37379
(423) 451-0623
(423) 451-0624
Mailing address
PO BOX 1059, SODDY DAISY, TN 37384
(423) 451-0623
(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
—
3887638
—
TN
Enumeration date
06/30/2006
Last updated
04/17/2014
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