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General NPI Number Information
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NPI Number | 1194019570
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Entity Type | Individual
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Provider Name | SUPRIYA KOHLI M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/03/2011
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Last Update Date | 12/07/2020
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Provider Practice Location Address
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Address Line | 1 MEDICAL CENTER BLVD SUITE 103
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City | COOKEVILLE
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State | TN
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Zip | 38501-4294
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Country | US
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Telephone | 931-783-2770
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Fax | 931-525-1176
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Provider Business Mailing Address
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Address Line | 230 LEXINGTON GREEN CIR STE 600
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City | LEXINGTON
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State | KY
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Zip | 40503-3326
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Country | US
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Telephone | 859-971-4695
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Fax | 859-971-4604
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 52489
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License Number State | TN
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