Provider Demographics
NPI:1922872324
Name:EWING, KNESHA
Entity Type:Individual
Prefix:
First Name:KNESHA
Middle Name:
Last Name:EWING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 JANETTE AVE
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-2750
Mailing Address - Country:US
Mailing Address - Phone:615-977-1970
Mailing Address - Fax:
Practice Address - Street 1:3807 DICKERSON PIKE STE I
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-1301
Practice Address - Country:US
Practice Address - Phone:615-564-1914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory