Individual
NIKISHIA BURSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2507 DODSON AVE, CHATTANOOGA, TN 37406-2445
(423) 508-7386
Mailing address
2507 DODSON AVE, CHATTANOOGA, TN 37406-2445
(423) 508-7386
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
OG6-1R7
TN
Other
Enumeration date
06/02/2020
Last updated
06/02/2020
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