Provider Demographics
NPI:1235271420
Name:DIABETES & GERIATRICS SPECIALIST LLC
Entity Type:Organization
Organization Name:DIABETES & GERIATRICS SPECIALIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PARDEEP
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-646-0880
Mailing Address - Street 1:146 S WILLOW AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-3191
Mailing Address - Country:US
Mailing Address - Phone:931-646-0880
Mailing Address - Fax:931-646-0884
Practice Address - Street 1:146 S WILLOW AVE
Practice Address - Street 2:SUITE A
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3191
Practice Address - Country:US
Practice Address - Phone:931-646-0880
Practice Address - Fax:931-646-0884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40259261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty