Healthcare Provider Details

I. General information

NPI: 1083671085
Provider Name (Legal Business Name): BELAY ESHETE TESSEMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BELAY TESSEMA ESHETE MD

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 DEBRA RD 5200
CHATTANOOGA TN
37411-5616
US

IV. Provider business mailing address

1500 NORTH WESTWOOD BLVD DEPARTMENT OF VETERANS AFFAIRS
POPLAR BLUFF MO
63901
US

V. Phone/Fax

Practice location:
  • Phone: 423-893-6500
  • Fax:
Mailing address:
  • Phone: 573-686-4151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number36345
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36345
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: