Provider Demographics
NPI:1245411255
Name:YOUSSEF, DIMA (MD)
Entity Type:Individual
Prefix:DR
First Name:DIMA
Middle Name:
Last Name:YOUSSEF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684-0699
Mailing Address - Country:US
Mailing Address - Phone:423-930-8337
Mailing Address - Fax:423-926-1049
Practice Address - Street 1:615 N STATE OF FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-8209
Practice Address - Country:US
Practice Address - Phone:423-930-8337
Practice Address - Fax:423-926-1049
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 46702207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1524621Medicaid
TNMD 46702OtherMEDICAL LICENSE