Provider Demographics
NPI:1942484787
Name:COFFEE COUNTY INTERNAL MEDICINE,PC
Entity Type:Organization
Organization Name:COFFEE COUNTY INTERNAL MEDICINE,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DINESH
Authorized Official - Middle Name:
Authorized Official - Last Name:AGNIHOTRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-454-9090
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-0157
Mailing Address - Country:US
Mailing Address - Phone:931-454-9090
Mailing Address - Fax:931-454-0773
Practice Address - Street 1:1330 CEDAR LN
Practice Address - Street 2:SUITE 1200
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2283
Practice Address - Country:US
Practice Address - Phone:931-454-9090
Practice Address - Fax:931-454-0773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39341207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3728587Medicaid
3728587OtherMEDICARE GROUP NUMBER
3728587OtherMEDICARE GROUP NUMBER