Active NPI
Soddy Daisy Pediatrics
- Pediatrics Physician
- Soddy Daisy, TN
National Provider Identifier
1124253257
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 37633
- Legal business name
- SODDY DAISY PEDIATRICS
- Practice address
- 8804 Dayton Pike Ste F
Soddy Daisy, TN 37379-4306 - Phone
- (423) 451-0622
- Fax
- (423) 451-0624
- NPI assigned
- May 19, 2009
- Last updated
- May 27, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Shahla A Kaukab, M.D.
- Title
- Owner
- Phone
- (423) 451-0622
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 37633 | TN | Primary |
Addresses
Primary practice location
8804 Dayton Pike Ste F
Soddy Daisy, TN 37379-4306
Mailing address
8804 Dayton Pike Ste F
Soddy Daisy, TN 37379-4306
Phone (423) 451-0622
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3804863 | Medicaid | TN | |
| 3887638 | Medicaid | TN |
National Provider Directory
National Provider Directory- Tax ID family
- Soddy Daisy Family Care
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Pediatrics Physician
- Soddy Daisy, TN
- NPI 1487995304
Locations
8804 Dayton Pike
#F
Soddy Daisy, TN 37379
Phone (423) 451-0622
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pediatrics Physician
- Soddy Daisy, TN
- NPI 1699703264
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1242691200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1243382400000",
"number": "1124253257",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8804 DAYTON PIKE STE F",
"city": "SODDY DAISY",
"state": "TN",
"postal_code": "373794306",
"telephone_number": "423-451-0622",
"fax_number": "423-451-0624"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8804 DAYTON PIKE STE F",
"city": "SODDY DAISY",
"state": "TN",
"postal_code": "373794306",
"telephone_number": "423-451-0622",
"fax_number": "423-451-0624"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SODDY DAISY PEDIATRICS",
"organizational_subpart": "NO",
"enumeration_date": "2009-05-19",
"last_updated": "2009-05-27",
"status": "A",
"authorized_official_last_name": "KAUKAB",
"authorized_official_first_name": "SHAHLA",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "423-451-0622",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TN",
"license": "37633",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3804863",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3887638",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Soddy Daisy, TN
- Jaclyn Brooke Smith, RN, CCM
- Juliana Sneed
- Soddy Daisy Family Care
- Soddy Daisy Healthcare, LLC (Soddy-Daisy Health Care Center)
- Soddy Daisy Medical Care
- Soddy-Daisy TN Opco LLC (Soddy-Daisy Healthcare Center)
- Southeast Eye Specialists, PLLC
- Southeastern Dental Associates of Soddy Daisy
- Bethany Marie Taylor, OTR/L
- Tennessee CVS Pharmacy LLC (CVS Pharmacy #05694)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.