Healthcare Provider Details

I. General information

NPI: 1194427120
Provider Name (Legal Business Name): LIDIA TESHOME DEGEFA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 HIGHYWAY 51 SOUTH
COVINGTON TN
38019
US

IV. Provider business mailing address

212 SUNSET PL UNIT B
REDFIELD AR
72132-8653
US

V. Phone/Fax

Practice location:
  • Phone: 901-476-2621
  • Fax:
Mailing address:
  • Phone: 901-364-1627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number18735
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number77230
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: