Provider Demographics
NPI:1376787788
Name:LOVE, TIUNDRA LESHAUN (DO)
Entity Type:Individual
Prefix:DR
First Name:TIUNDRA
Middle Name:LESHAUN
Last Name:LOVE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NA
Other - Middle Name:NA
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:4112 ROGERS RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-3242
Mailing Address - Country:US
Mailing Address - Phone:423-622-0599
Mailing Address - Fax:
Practice Address - Street 1:6098 DEBRA ROAD, BLDG 6200 SUITE 5200
Practice Address - Street 2:VHA
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411
Practice Address - Country:US
Practice Address - Phone:423-893-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002365207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine