Healthcare Provider Details

I. General information

NPI: 1144412123
Provider Name (Legal Business Name): KANDI MCMAHAN MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1225 E WEISGARBER RD SUITE 180 SOUTH
KNOXVILLE TN
37909-2604
US

IV. Provider business mailing address

1225 E WEISGARBER RD SUITE 180 SOUTH
KNOXVILLE TN
37909-2604
US

V. Phone/Fax

Practice location:
  • Phone: 865-684-5558
  • Fax: 865-584-6607
Mailing address:
  • Phone: 865-684-5558
  • Fax: 865-584-6607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3489
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: