Healthcare Provider Details

I. General information

NPI: 1962324467
Provider Name (Legal Business Name): JEFFREY MCCORMICK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 OIL WELL RD
JACKSON TN
38305-7352
US

IV. Provider business mailing address

410 OIL WELL RD
JACKSON TN
38305-7352
US

V. Phone/Fax

Practice location:
  • Phone: 731-664-4408
  • Fax:
Mailing address:
  • Phone: 731-664-4408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number922
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: