Provider Demographics
NPI:1164511317
Name:ZEMICHAEL, DAWIT (MD)
Entity type:Individual
Prefix:
First Name:DAWIT
Middle Name:
Last Name:ZEMICHAEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-3636
Mailing Address - Country:US
Mailing Address - Phone:615-278-2241
Mailing Address - Fax:615-904-9182
Practice Address - Street 1:1805 INGLESIDE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-2105
Practice Address - Country:US
Practice Address - Phone:423-745-8802
Practice Address - Fax:423-745-8800
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN314662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3851684Medicare ID - Type Unspecified
TNH12320Medicare UPIN