DETRA MICHELLE TISDALE

CORDOVA, TN
NPI1730273079
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy207R00000X Internal Medicine
(Licence: TN  46435)
Additional Taxonomies207R00000X Internal Medicine
(Licence: GA  053713)
207R00000X Internal Medicine
(Licence: LA  MD202661)
Enumeration Date2006-10-03
Last Update Date2010-12-06
Business Address
Dr. DETRA MICHELLE TISDALE M.D.
1144 N HOUSTON LEVEE RD SUITE 102
CORDOVA, TN 38018-7145
Phone number: 901-382-2044
Mailing Address
Dr. DETRA MICHELLE TISDALE M.D.
1144 N HOUSTON LEVEE RD SUITE 102
CORDOVA, TN 38018-7145
Phone number: