Healthcare Provider Details

I. General information

NPI: 1558212001
Provider Name (Legal Business Name): MARINA FAWZY HEFZY GAYED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 DUKE ST
ASHLAND CITY TN
37015-1514
US

IV. Provider business mailing address

4532 HIGHLAND RIDGE DR
ANTIOCH TN
37013-2942
US

V. Phone/Fax

Practice location:
  • Phone: 629-289-3136
  • Fax: 423-569-4909
Mailing address:
  • Phone: 615-635-1899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: