Healthcare Provider Details

I. General information

NPI: 1952444671
Provider Name (Legal Business Name): MARTHA MICHELLE MCCORMICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HOLLIMAN LN
CARTHAGE TN
37030-2315
US

IV. Provider business mailing address

24 HOLLIMAN LN
CARTHAGE TN
37030-2315
US

V. Phone/Fax

Practice location:
  • Phone: 615-735-0242
  • Fax: 615-735-8250
Mailing address:
  • Phone: 615-735-0242
  • Fax: 615-735-8250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: