Healthcare Provider Details

I. General information

NPI: 1902156755
Provider Name (Legal Business Name): MARTIN WOON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W FOREST AVE STE 200
JACKSON TN
38301-3940
US

IV. Provider business mailing address

257 BANCORP SOUTH PKWY
JACKSON TN
38305-7582
US

V. Phone/Fax

Practice location:
  • Phone: 731-541-9490
  • Fax: 731-541-9486
Mailing address:
  • Phone: 731-512-1283
  • Fax: 731-660-8739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number36320
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3982
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number36320
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: