| Soddy Daisy Family Care | |
|
9089 Dayton Pike Soddy Daisy TN 37379-4313 | |
| (423) 451-0622 | |
| (423) 451-0624 |
| Full Name | Soddy Daisy Family Care |
|---|---|
| Speciality | Pediatrics |
| Location | 9089 Dayton Pike, Soddy Daisy, Tennessee |
| Authorized Official Name and Position | Shahla A Kaukab (OWNER) |
| Authorized Official Contact | 4234510623 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Soddy Daisy Family Care 9089 Dayton Pike Soddy Daisy TN 37379 Ph: (423) 451-0622 | Soddy Daisy Family Care 9089 Dayton Pike Soddy Daisy TN 37379-4313 Ph: (423) 451-0622 |
| NPI Number | 1487995304 |
|---|---|
| Provider Enumeration Date | 03/04/2013 |
| Last Update Date | 05/12/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487995304 | NPI | - | NPPES |
| 1509389 | Medicaid | TN | |
| 3887638 | Medicaid | TN | |
| 1511723 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 29446 (Tennessee) | Secondary |
| 208000000X | Pediatrics | 37633 (Tennessee) | Primary |
| 208000000X | Pediatrics | 28243 (Tennessee) | Secondary |
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Soddy Daisy Medical Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 9089 Dayton Pike, Soddy Daisy, TN 37379 Phone: 423-451-0622 Fax: 423-451-0624 | |
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