Provider Demographics
NPI:1538680590
Name:CORNELIUS, TUHINA (MD)
Entity Type:Individual
Prefix:
First Name:TUHINA
Middle Name:
Last Name:CORNELIUS
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 1:6029 WALNUT GROVE RD
Mailing Address - Street 2:STE 209
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2112
Mailing Address - Country:US
Mailing Address - Phone:901-681-0778
Mailing Address - Fax:901-821-9987
Practice Address - Street 1:6029 WALNUT GROVE RD
Practice Address - Street 2:STE 209
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2112
Practice Address - Country:US
Practice Address - Phone:901-681-0778
Practice Address - Fax:901-821-9987
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS29694207RI0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00481573Medicaid
TNQ073722Medicaid