Provider Demographics
NPI:1205107935
Name:SOHI, AZAM H (MD)
Entity type:Individual
Prefix:
First Name:AZAM
Middle Name:H
Last Name:SOHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHAHNAZ
Other - Middle Name:H
Other - Last Name:SOHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2333 MCCALLIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3258
Mailing Address - Country:US
Mailing Address - Phone:423-698-6061
Mailing Address - Fax:
Practice Address - Street 1:2333MCCALLIE AVENUE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404
Practice Address - Country:US
Practice Address - Phone:423-698-6061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47772207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003123383CMedicaid
GA003123383CMedicaid
GA003123383CMedicare PIN