Healthcare Provider Details

I. General information

NPI: 1073578738
Provider Name (Legal Business Name): YVONNE MCMAHON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 W BROAD ST
COOKEVILLE TN
38501-2331
US

IV. Provider business mailing address

425 S MAPLE AVE
COOKEVILLE TN
38501-3582
US

V. Phone/Fax

Practice location:
  • Phone: 931-528-1485
  • Fax:
Mailing address:
  • Phone: 931-528-0095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD0000017671
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: