Provider Demographics
NPI:1679112734
Name:TESFAMICHAL, MERHAWE
Entity type:Individual
Prefix:
First Name:MERHAWE
Middle Name:
Last Name:TESFAMICHAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 DICKERSON PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-4564
Mailing Address - Country:US
Mailing Address - Phone:615-582-3291
Mailing Address - Fax:
Practice Address - Street 1:2401 DICKERSON PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-4564
Practice Address - Country:US
Practice Address - Phone:615-582-3291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty