Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 26164 | TN |
N | 207VX0000X | Obstetrician | 288350 | GA |
NPI | 1275186504 |
---|---|
Provider Name | Tessa B Eckhardt |
First Address | Hixson, TN 37343-2068 |
Second Address | Ooltewah, TN 37363-6561 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2019 |
Last Update Date | 16/07/2019 |