Provider Demographics
NPI:1588473623
Name:CHEKOL, BEZAWIT
Entity type:Individual
Prefix:MRS
First Name:BEZAWIT
Middle Name:
Last Name:CHEKOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5447 PISANO ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-1543
Mailing Address - Country:US
Mailing Address - Phone:615-414-9967
Mailing Address - Fax:
Practice Address - Street 1:5447 PISANO ST
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-1543
Practice Address - Country:US
Practice Address - Phone:615-414-9967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN106781303172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver