Provider Demographics
NPI:1972573038
Name:COVINGTON GRESHAM, TINA DARNISE (MD)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:DARNISE
Last Name:COVINGTON GRESHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:DARNISE
Other - Last Name:COVINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:745 S CHURCH ST STE 601A
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-4980
Mailing Address - Country:US
Mailing Address - Phone:615-295-2411
Mailing Address - Fax:833-902-3584
Practice Address - Street 1:745 S CHURCH ST STE 601A
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-4980
Practice Address - Country:US
Practice Address - Phone:615-295-2411
Practice Address - Fax:833-902-3584
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD024607174400000X
TN24607207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3717981Medicaid
TNQ028466Medicaid
TNE72868Medicare UPIN
TN3717981Medicaid