Provider Demographics
NPI:1477256618
Name:DUSHIME, INNOCENT
Entity Type:Individual
Prefix:MR
First Name:INNOCENT
Middle Name:
Last Name:DUSHIME
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 DREMA CT
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37127-6545
Mailing Address - Country:US
Mailing Address - Phone:615-585-7264
Mailing Address - Fax:
Practice Address - Street 1:318 DREMA CT
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37127-6545
Practice Address - Country:US
Practice Address - Phone:615-585-7264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty