Provider Demographics
NPI:1053430462
Name:PINN, TANIKA M (MD)
Entity type:Individual
Prefix:DR
First Name:TANIKA
Middle Name:M
Last Name:PINN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2278
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28502-2278
Mailing Address - Country:US
Mailing Address - Phone:252-522-9800
Mailing Address - Fax:252-523-9790
Practice Address - Street 1:1114 W 7TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-1810
Practice Address - Country:US
Practice Address - Phone:931-388-9706
Practice Address - Fax:931-490-1062
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43965207QS0010X, 207Q00000X
NC2020-04516207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1518287Medicaid
TN3710144OtherGROUP - MEDICARE
TN103I089193OtherMEDICARE