Provider Demographics
NPI:1083059265
Name:TESSEMA, JUDITH ANNE
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANNE
Last Name:TESSEMA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 NUCKOLLS RD
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:TN
Mailing Address - Zip Code:38008-1599
Mailing Address - Country:US
Mailing Address - Phone:731-658-3388
Mailing Address - Fax:
Practice Address - Street 1:629 NUCKOLLS RD
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:TN
Practice Address - Zip Code:38008-1599
Practice Address - Country:US
Practice Address - Phone:731-658-3388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN62446207Q00000X
CAA136409207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine