Soddy Daisy Family Care

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

37633 Issued in TN

Legal business name

SODDY DAISY FAMILY CARE

Practice address

9089 Dayton Pike
Soddy Daisy, TN 37379-4313

Phone

(423) 451-0622

Fax

(423) 451-0624

NPI assigned

Mar 4, 2013

Last updated

May 12, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Shahla A Kaukab, MDNPI 1699703264

Title

Owner

Phone

(423) 451-0623

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• Soddy Daisy Pediatrics Former legal business name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Soddy Daisy Family Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Soddy Daisy Pediatrics

  • Pediatrics Physician
  • Soddy Daisy, TN
  • NPI 1124253257
  NPD tax ID

Locations

Practitioners 2

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.

• Shahla Amjad Kaukab, M.D.

  • Pediatrics Physician
  • Soddy Daisy, TN
  • NPI 1699703264
  NPD (past) Authorized official
• Kaukab Naseer, M.D.

  • Pediatrics Physician
  • Chattanooga, TN
  • NPI 1326036930
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1362355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494547200000",
    "number": "1487995304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9089 DAYTON PIKE",
            "city": "SODDY DAISY",
            "state": "TN",
            "postal_code": "37379",
            "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": "9089 DAYTON PIKE",
            "city": "SODDY DAISY",
            "state": "TN",
            "postal_code": "373794313",
            "telephone_number": "423-451-0622",
            "fax_number": "423-451-0624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SODDY DAISY FAMILY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-04",
        "last_updated": "2017-05-12",
        "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": "423-451-0623",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "29446",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "37633",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "28243",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1509389",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3887638",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1511723",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Soddy Daisy Pediatrics",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Latisha Monique Simmons, DSW
• Deidra Gayle Smith, RN
• Elizabeth Culbreath Smith, MSN, NP-C
• Jaclyn Brooke Smith, RN, CCM
• Juliana Sneed
• Soddy Daisy Healthcare, LLC (Soddy-Daisy Health Care Center)
• Soddy Daisy Medical Care
• Soddy Daisy Pediatrics
• Soddy-Daisy TN Opco LLC (Soddy-Daisy Healthcare Center)
• Southeast Eye Specialists, PLLC

• Pediatrics Physician in Soddy Daisy, TN
• Providers in Soddy Daisy, TN by specialty
• Pediatrics Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.