Healthcare Provider Details

I. General information

NPI: 1295942720
Provider Name (Legal Business Name): DEREK MEACHAM MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4249 HIGHWAY 411 STE 4
MADISONVILLE TN
37354-1544
US

IV. Provider business mailing address

1200 CORPORATE DR STE 300
BIRMINGHAM AL
35242-2944
US

V. Phone/Fax

Practice location:
  • Phone: 423-442-4034
  • Fax: 423-442-6463
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number17976
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11131
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: