Provider Demographics
NPI:1508907924
Name:CARTER, TEKUILA RENEE (MD)
Entity Type:Individual
Prefix:
First Name:TEKUILA
Middle Name:RENEE
Last Name:CARTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TEKUILA
Other - Middle Name:RENEE
Other - Last Name:BIRDSONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1211 21ST AVE S
Mailing Address - Street 2:701 MEDICAL ARTS BUILDING
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2717
Mailing Address - Country:US
Mailing Address - Phone:615-936-3779
Mailing Address - Fax:
Practice Address - Street 1:1211 21ST AVE S
Practice Address - Street 2:MEDICAL ARTS BUILDING, ROOM 701
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2717
Practice Address - Country:US
Practice Address - Phone:615-936-3779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000043487207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology