Healthcare Provider Details

I. General information

NPI: 1366508681
Provider Name (Legal Business Name): DEEPIKA A TUMKUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 HIGHWAY 19 E
BLUFF CITY TN
37618-1865
US

IV. Provider business mailing address

PO BOX 850
ROGERSVILLE TN
37857-0850
US

V. Phone/Fax

Practice location:
  • Phone: 423-538-5116
  • Fax: 423-538-3861
Mailing address:
  • Phone: 423-538-5116
  • Fax: 423-538-3861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101246399
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number41795
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: