Healthcare Provider Details

I. General information

NPI: 1053430462
Provider Name (Legal Business Name): TANIKA M. PINN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 W 7TH ST
COLUMBIA TN
38401-1810
US

IV. Provider business mailing address

PO BOX 2278
KINSTON NC
28502-2278
US

V. Phone/Fax

Practice location:
  • Phone: 931-388-9706
  • Fax: 931-490-1062
Mailing address:
  • Phone: 252-522-9800
  • Fax: 252-523-9790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number43965
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2020-04516
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number43965
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: