Provider Demographics
NPI:1366786352
Name:GUYASSA, TESFAYE REGAA (MD)
Entity type:Individual
Prefix:DR
First Name:TESFAYE
Middle Name:REGAA
Last Name:GUYASSA
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 1:109 KELLY DR
Mailing Address - Street 2:
Mailing Address - City:DECHERD
Mailing Address - State:TN
Mailing Address - Zip Code:37324
Mailing Address - Country:US
Mailing Address - Phone:240-595-7324
Mailing Address - Fax:
Practice Address - Street 1:109 KELLY DR
Practice Address - Street 2:
Practice Address - City:DECHERD
Practice Address - State:TN
Practice Address - Zip Code:37324-3805
Practice Address - Country:US
Practice Address - Phone:240-595-7324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN51431207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine