Healthcare Provider Details

I. General information

NPI: 1346566973
Provider Name (Legal Business Name): LINDA C ESUZOR M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER BLVD SUITE 103
COOKEVILLE TN
38501-4294
US

IV. Provider business mailing address

127 N OAK AVE SUITE D
COOKEVILLE TN
38501-2435
US

V. Phone/Fax

Practice location:
  • Phone: 931-783-2770
  • Fax: 931-525-1176
Mailing address:
  • Phone: 931-783-5857
  • Fax: 931-526-6760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP5623
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD48965
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: