Basic Information
| Provider Information | |||||||||
| NPI: | 1235358938 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADESHINA | ||||||||
| FirstName: | TAWANDA | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | COVEN | ||||||||
| OtherFirstName: | TAWANDA | ||||||||
| OtherMiddleName: | G | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7305 JARNIGAN ROAD | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234954345 | ||||||||
| FaxNumber: | 4234954934 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 KINGTON LANE | ||||||||
| Address2: | |||||||||
| City: | CHICKAMAUGA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063759400 | ||||||||
| FaxNumber: | 7063759491 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2007 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 070692 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | A98895 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 57005 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.