Healthcare Provider Details

I. General information

NPI: 1972573038
Provider Name (Legal Business Name): TINA DARNISE COVINGTON GRESHAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TINA DARNISE COVINGTON

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 S CHURCH ST STE 601A
MURFREESBORO TN
37130-4980
US

IV. Provider business mailing address

745 S CHURCH ST STE 601A
MURFREESBORO TN
37130-4980
US

V. Phone/Fax

Practice location:
  • Phone: 615-295-2411
  • Fax: 833-902-3584
Mailing address:
  • Phone: 615-295-2411
  • Fax: 833-902-3584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD024607
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number24607
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: